Impact of a New Assessment System, the MDS-HC, on Function and Hospitalization of Homebound Older People: A Controlled Clinical Trial

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 49; no. 10; pp. 1288 - 1293
• Main Authors: Landi, Francesco, Onder, Graziano, Tua, Ennio, Carrara, Benigno, Zuccalá, Giuseppe, Gambassi, Giovanni, Carbonin, PierUgo, Bernabei, Roberto
• Format: Journal Article
• Language: English
• Published: Boston, MA, USA Blackwell Science Inc 01.10.2001; Blackwell; Wiley Subscription Services, Inc
• Subjects: Activities of Daily Living; Aged; Analysis of Variance; Assessment; Biological and medical sciences; Community living; comprehensive geriatric assessment; costs; Costs and Cost Analysis; Elder care; Elderly people; Female; Follow-Up Studies; Frail Elderly; Functional status; Geriatric Assessment; Geriatrics; Health care expenditures; Health Services for the Aged - statistics & numerical data; Home care; Home Care Services - economics; Home Care Services - organization & administration; Home health care; Hospitalization; Hospitalization - statistics & numerical data; Humans; Male; Medical sciences; Miscellaneous; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Statistics, Nonparametric; Italy; Europe; Human; Evaluation; Sanitary program; Hospitalization; Survival; Care; Randomization; Health economy; At home; Decision aid; Clinical trial; Clinical investigation; Cost analysis; Elderly; Public health
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1046/j.1532-5415.2001.49264.x

OBJECTIVES: To evaluate the impact of a new assessment system, the Minimum Data Set for Home Care (MDS‐HC), on the functional status and hospitalization rates of frail, community‐dwelling older people. DESIGN: Single‐blind randomized trial with 1‐year follow‐up. SETTING: Bergamo, Italy. PARTICIPANTS: All 187 subjects who were eligible for home care services delivered by two Health Districts between September 1998 and April 1999. INTERVENTION: Random allocation to an intervention group undergoing MDS‐HC assessment or to a control group receiving conventional geriatric assessment with Barthel, Lawton and Brody, and Mini‐Mental State Examination (MMSE) scales. MEASUREMENTS: Hospitalization, health services use and costs, and variations in functional status. RESULTS: Survival analysis indicated that the intervention group was admitted to the hospital later and less often than were controls (relative risk = 0.49, 95% confidence interval = 0.56–0.97). Health services were used to the same extent, but intervention subjects used more in‐home help services. Total costs for the intervention group were 21% lower than for the control group. The adjusted mean scores of the activities of daily living index (51.7±36.1 vs 46.3±33.7; P = .05) and MMSE (19.9±8.9 vs 19.2±10.7; P = .03) were significantly improved in the intervention group as compared with the control group. CONCLUSIONS: The MDS‐HC assessment instrument may provide a cost‐saving approach to reducing institutionalization and functional decline in older people living in the community. J Am Geriatr Soc 49:1288–1293, 2001.