Authors: Kodner D and Kyriacou C

Journal: International Journal of Integrated Care, 2000

Volume/pages: Vol 1, pp1-19

About the study

The paper reviews and compares two models of "œfully integrated" care targeted at frail older people in the US: the social health maintenance organisation (Social HMO) and the program of all-inclusive care for the elderly (PACE). Both models have existed for 20 years and are funded through Medicare. PACE provides integrated care through interdisciplinary teams based in adult day health centres. The Social HMO combines health and social care under a single care-managed delivery system in 4 US states, and depends upon less formal multidisciplinary communication and collaboration between health and social care providers.

Findings

The authors present a summary of the findings from multiple evaluations of the two models. The Social HMO: While true integration at the clinical level was not achieved, service users experienced good continuity of care. The model actually saw an increase in hospital and nursing home admissions. There were no overall cost savings. 80-95% of service users were satisfied with the programme regarding access and convenience, quality and competence of care, finances and benefits, interpersonal relations, and general satisfaction. PACE: This was an effective model of integration, with pooling of funds allowing for service flexibility. Hospital and nursing home admissions and lengths of stay were reduced, and overall costs were lower than standard services. Participants reported after 6 months a higher quality of life, better health, and greater confidence.

Key Messages for practice

• Differences in the way evaluations are reported can make it difficult to compare the effectiveness of different models of integration

• The development of fully integrated models of care is a feasible and effective way of improving the delivery of care and its outcomes for service users with complex conditions.