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Research

Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial

Marijke Boorsma, Dinnus H.M. Frijters, Dirk L. Knol, Miel E. Ribbe, Giel Nijpels and Hein P.J. van Hout
CMAJ August 09, 2011 183 (11) E724-E732; DOI: https://doi.org/10.1503/cmaj.101498
Marijke Boorsma
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Dinnus H.M. Frijters
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Dirk L. Knol
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Miel E. Ribbe
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Giel Nijpels
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Hein P.J. van Hout
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  • For correspondence: hpj.vanhout@vumc.nl
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Abstract

Background: Sophisticated approaches are needed to improve the quality of care for elderly people living in residential care facilities. We determined the effects of multidisciplinary integrated care on the quality of care and quality of life for elderly people in residential care facilities.

Methods: We performed a cluster randomized controlled trial involving 10 residential care facilities in the Netherlands that included 340 participating residents with physical or cognitive disabilities. Five of the facilities applied multidisciplinary integrated care, and five provided usual care. The intervention, inspired by the disease management model, consisted of a geriatric assessment of functional health every three months. The assessment included use of the Long-term Care Facility version of the Resident Assessment Instrument by trained nurse-assistants to guide the design of an individualized care plan; discussion of outcomes and care priorities with the family physician, the resident and his or her family; and monthly multidisciplinary meetings with the nurse-assistant, family physician, psychologist and geriatrician to discuss residents with complex needs. The primary outcome was the sum score of 32 risk-adjusted quality-of-care indicators.

Results: Compared with the facilities that provided usual care, the intervention facilities had a significantly higher sum score of the 32 quality-of-care indicators (mean difference − 6.7, p = 0.009; a medium effect size of 0.72). They also had significantly higher scores for 11 of the 32 indicators of good care in the areas of communication, delirium, behaviour, continence, pain and use of antipsychotic agents.

Interpretation: Multidisciplinary integrated care resulted in improved quality of care for elderly people in residential care facilities compared with usual care.

Trial registration: www.controlled-trials.com trial register no. ISRCTN11076857.

See related commentary by Stadnyk and colleagues at www.cmaj.ca/lookup/doi/10.1503/cmaj.110789.

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Canadian Medical Association Journal: 183 (11)
CMAJ
Vol. 183, Issue 11
9 Aug 2011
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Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial
Marijke Boorsma, Dinnus H.M. Frijters, Dirk L. Knol, Miel E. Ribbe, Giel Nijpels, Hein P.J. van Hout
CMAJ Aug 2011, 183 (11) E724-E732; DOI: 10.1503/cmaj.101498

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Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial
Marijke Boorsma, Dinnus H.M. Frijters, Dirk L. Knol, Miel E. Ribbe, Giel Nijpels, Hein P.J. van Hout
CMAJ Aug 2011, 183 (11) E724-E732; DOI: 10.1503/cmaj.101498
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Cited By...

  • Validation of an integrated service model, Health-RESPECT, for older patients in long-term care institution using information and communication technologies: protocol of a cluster randomised controlled trial
  • Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review
  • Development and Validation of the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE) Instrument
  • Residential care facilities providing multidisciplinary integrated care for older people achieve higher scores on 32 risk-adjusted quality of care indicators than facilities providing usual care
  • Improving quality of care in nursing homes: What works?
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