text: Effectiveness of team-managed home-based primary care: a randomized multicenter trial. - PubMed - NCBI
  Format: AbstractFormatSummarySummary (text)AbstractAbstract (text)MEDLINEXMLPMID ListApplySend toChoose DestinationFileClipboardCollectionsE-mailOrderMy BibliographyCitation managerFormatSummary (text)Abstract (text)MEDLINEXMLPMID ListCSVCreate File1 selected item: 11147984FormatSummarySummary (text)AbstractAbstract (text)MEDLINEXMLPMID ListMeSH and Other DataE-mailSubjectAdditional textE-mailDidn't get the message? Find out why...Add to ClipboardAdd to CollectionsOrder articlesAdd to My BibliographyGenerate a file for use with external citation management software.Create File
  See comment in PubMed Commons belowJAMA. 2000 Dec 13;284(22):2877-85.Effectiveness of team-managed home-based primary care: a randomized multicenter trial.Hughes SL1, Weaver FM, Giobbie-Hurder A, Manheim L, Henderson W, Kubal JD, Ulasevich A, Cummings J; Department of Veterans Affairs Cooperative Study Group on Home-Based Primary Care.Author information1Cooperative Studies Program Coordinating Center, Edward A. Hines Jr Veterans Affairs Hospital, Hines, Ill, USA. shughes@uic.eduAbstractCONTEXT: Although home-based health care has grown over the past decade, its effectiveness remains controversial. A prior trial of Veterans Affairs (VA) Team-Managed Home-Based Primary Care (TM/HBPC) found favorable outcomes, but the replicability of the model and generalizability of the findings are unknown.OBJECTIVES: To assess the impact of TM/HBPC on functional status, health-related quality of life (HR-QoL), satisfaction with care, and cost of care.DESIGN AND SETTING: Multisite randomized controlled trial conducted from October 1994 to September 1998 in 16 VA medical centers with HBPC programs.PARTICIPANTS: A total of 1966 patients with a mean age of 70 years who had 2 or more activities of daily living impairments or a terminal illness, congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD). Intervention Home-based primary care (n=981), including a primary care manager, 24-hour contact for patients, prior approval of hospital readmissions, and HBPC team participation in discharge planning, vs customary VA and private sector care (n=985).MAIN OUTCOME MEASURES: Patient functional status, patient and caregiver HR-QoL and satisfaction, caregiver burden, hospital readmissions, and costs over 12 months.RESULTS: Functional status as assessed by the Barthel Index did not differ for terminal (P=.40) or nonterminal (those with severe disability or who had CHF or COPD) (P=.17) patients by treatment group. Significant improvements were seen in terminal TM/HBPC patients in HR-QoL scales of emotional role function, social function, bodily pain, mental health, vitality, and general health. Team-Managed HBPC nonterminal patients had significant increases of 5 to 10 points in 5 of 6 satisfaction with care scales. The caregivers of terminal patients in the TM/HBPC group improved significantly in HR-QoL measures except for vitality and general health. Caregivers of nonterminal patients improved significantly in QoL measures and reported reduced caregiver burden (P=.008). Team-Managed HBPC patients with severe disability experienced a 22% relative decrease (0.7 readmissions/patient for TM/HBPC group vs 0.9 readmissions/patient for control group) in hospital readmissions (P=.03) at 6 months that was not sustained at 12 months. Total mean per person costs were 6.8% higher in the TM/HBPC group at 6 months ($19190 vs $17971) and 12.1% higher at 12 months ($31401 vs $28008).CONCLUSIONS: The TM/HBPC intervention improved most HR-QoL measures among terminally ill patients and satisfaction among non-terminally ill patients. It improved caregiver HR-QoL, satisfaction with care, and caregiver burden and reduced hospital readmissions at 6 months, but it did not substitute for other forms of care. The higher costs of TM/HBPC should be weighed against these benefits.PMID: 11147984 [PubMed - indexed for MEDLINE] SharePublication Types, MeSH TermsPublication TypesClinical TrialMulticenter StudyRandomized Controlled TrialResearch Support, U.S. Gov't, Non-P.H.S.MeSH TermsActivities of Daily LivingAgedFemaleHealth Care CostsHeart FailureHome Care Services/economicsHome Care Services/organization & administration*Hospitalization/statistics & numerical dataHospitals, Veterans/economicsHospitals, Veterans/utilizationHumansLung Diseases, ObstructiveMaleMiddle AgedOutcome and Process Assessment (Health Care)Patient Care Management*Patient Care TeamPatient SatisfactionPrimary Health Care/economicsPrimary Health Care/organization & administration*Quality of LifeStatistics, NonparametricTerminally IllUnited StatesLinkOut - more resourcesFull Text SourcesSilverchair Information SystemsOvid Technologies, Inc.Other Literature SourcesCOS Scholar UniverseMedicalClinicalTrials.govHome Care Services - MedlinePlus Health InformationMiscellaneousNCI CPTAC Assay PortalPubMed Commons home