Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: An individual participant data meta-analysis

The Topics-Mds Research Consortium

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.
Original languageEnglish
Pages (from-to)705-714
JournalAge and Ageing
Volume47
Issue number5
DOIs
Publication statusPublished - 2018

Cite this

@article{8af014a465e54eb682868a5bf5f8058a,
title = "Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: An individual participant data meta-analysis",
abstract = "Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3{\%}) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95{\%} confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5{\%}. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.",
author = "{The Topics-Mds Research Consortium} and Blom, {J. W.} and {van den Hout}, {W. B.} and {den Elzen}, {W. P. J.} and Drewes, {Y. M.} and N. Bleijenberg and Fabbricotti, {I. N.} and Jansen, {A. P. D.} and Kempen, {G. I. J. M.} and R. Koopmans and Looman, {W. M.} and Melis, {R. J. F.} and Metzelthin, {S. F.} and {van Charante}, {E. P. Moll} and Muntinga, {M. E.} and Numans, {M. E.} and Ruikes, {F. G. H.} and Spoorenberg, {S. L. W.} and T. Stijnen and Suijker, {J. J.} and {de Wit}, {N. J.} and K. Wynia and Wind, {A. W.} and J. Gussekloo",
year = "2018",
doi = "10.1093/ageing/afy091",
language = "English",
volume = "47",
pages = "705--714",
journal = "Age and Ageing",
issn = "0002-0729",
publisher = "Oxford University Press",
number = "5",

}

Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: An individual participant data meta-analysis. / The Topics-Mds Research Consortium.

In: Age and Ageing, Vol. 47, No. 5, 2018, p. 705-714.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: An individual participant data meta-analysis

AU - The Topics-Mds Research Consortium

AU - Blom, J. W.

AU - van den Hout, W. B.

AU - den Elzen, W. P. J.

AU - Drewes, Y. M.

AU - Bleijenberg, N.

AU - Fabbricotti, I. N.

AU - Jansen, A. P. D.

AU - Kempen, G. I. J. M.

AU - Koopmans, R.

AU - Looman, W. M.

AU - Melis, R. J. F.

AU - Metzelthin, S. F.

AU - van Charante, E. P. Moll

AU - Muntinga, M. E.

AU - Numans, M. E.

AU - Ruikes, F. G. H.

AU - Spoorenberg, S. L. W.

AU - Stijnen, T.

AU - Suijker, J. J.

AU - de Wit, N. J.

AU - Wynia, K.

AU - Wind, A. W.

AU - Gussekloo, J.

PY - 2018

Y1 - 2018

N2 - Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.

AB - Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85055192861&origin=inward

U2 - 10.1093/ageing/afy091

DO - 10.1093/ageing/afy091

M3 - Article

VL - 47

SP - 705

EP - 714

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 5

ER -