Workshop: health technology assessment of integrated home care for frial elder somatic patients

BACKGROUND: The fragmented delivery of healthcare and social services as advanced by WHO 2002. OBJECTIVES: This project of international collaboration assesses integrated home care (IHC) for frail elder somatic patients as compared to usual hospital care. METHODS: The HTA follows the special application for Tele-medicine (MAST). An introductory literature review identified stroke, heart failure (HF) and COPD as prototypes of IHC. Pre-existing evidence has been complemented by additional trials and surveys. RESULTS: 1. Definition/organization of IHC: 1. Is carried out by a multidisciplinary team visiting the home. 2. Considers effectiveness, quality, access and user satisfaction in an economic way and uses Tele-facilities as far as they serve these goals. 3. Has finance across organizational settings. 2. Clinical effectiveness of IHC for moderately disabled patients by 6–12 months follow-up: Stroke: In 14 randomized trials (n=2139) intervention patients were by meta-analysis significantly less likely (p=0.001) to be dead or dependent compared with conventional care. HF: 2 RCT (n=386) demonstrate each a significant reduction of all-cause readmissions (p=0.003 and p=0.001). COPD: 5 studies (2 RCT, 2 cohorts and 1 CT) (n=1249) demonstrate each a significant reduction in readmissions/total admission days (p<0.05). 3. Health economic evaluation: For each selected condition the first year benefit surmounts the costs of intervention using the Dutch Standardization by Oostenbrink as a common price catalogue across resources/trials/countries. 4. Patient satisfaction: Focus group interviews confirm literature findings of very good satisfaction by IHC both among patients/carers and health professionals. DISCUSSION: Calculated net savings of 1450€ per patient in IHC are not supposed to materialize in ‘cool’- cash but enables local negotiation of adapted solutions with a minimum of national legislation/finance (Meso-strategy of dissemination). IMPLICATIONS: IHC is an approach to clinical continuity for a majority of frail elder somatic patients.