The cost-effectiveness of integrated home care and discharge practice for home care patients.
OBJECTIVES
To evaluate the effects of integrated home care and discharge practice (IHCaD-practice) on the use of services and cost-effectiveness.


METHODS
A cluster randomised trial with Finnish municipalities (n=22) as the units of randomisation. At baseline the sample included 668 home care patients aged 65 years or over. Data consisted of interviews (discharge, 3-week, 6-month) and care registers. The intervention was a generic prototype of care/case management-practice that was tailored to each municipality's needs. The effects were evaluated in terms of the use and cost of health and social care services. Unit costs of services were calculated. Cost-effectiveness was calculated for changes in health-related quality of life using the Nottingham Health Profile (NHP) and the EQ-5D instruments. All analyses were based on intention-to-treat.


RESULTS
At 6-month follow-ups, the patients in the trail group used less home care, doctor and laboratory services than patients in the non-trial group. Similar differences between groups were found regarding costs. According to the NHP instrument, the IHCaD-practice showed higher cost-effectiveness compared to the old practice. No evidence for cost-effectiveness was found with the EQ-5D instrument.


CONCLUSIONS
The study suggests that the IHCaD-practice may be a cost-effective alternative to usual care.