Integrated Home Care Programs for frail older people: evidence from a systematic review

Background Frail older people living with long-term conditions present a complex and long-term need of a high number of health and social services preferably delivered at home. Integration and coordination among different providers is required to guarantee good access and continuity of care. The aim of this research was to synthetize the evidence on the impact of Integrated Home Care Programs (IHCPs) for frail elderly on health outcomes, processes and resource utilization. Methods A systematic review was carried out on electronic databases. Articles evaluating IHCPs for people aged 65 or more living at home and measuring health outcomes, healthcare processes or resource utilization were included. Quality assessment of the studies was performed. Principal findings were grouped on the basis of the 3 item categories studied and synthetized according to the 3 levels of scientific evidence (strong, moderate or insufficient). Results A total of 7890 citations were retrieved and 14 articles were included in the review. Nine studies (64%) reported at least 1 health outcome. Strong positive evidence was found for improvement in Activities of Daily Living (ADL), Instrumental ADL and cognitive function and for patient satisfaction. Moderate evidence of improvement in quality of life and global health perception was shown. Twelve studies (86%) measured healthcare processes. Strong positive evidence was found in reducing preventable and all admissions to acute services and risk of institutionalization. Evidence of improved access to health and social services was also strong. Finally, two studies evaluated resource utilization but, though the findings suggest a reduction in costs of care, the evidence was insufficient. Conclusions IHCPs showed strong positive impact on health outcomes and healthcare processes. These findings encourage top-level decision makers (policy makers and managers of provider organization) to pursue the development of this kind of programs. Key messages: Integrated Home Care programs for frail elderly improves both health outcomes and processes. Health policy promoting integration among health and social providers is required to guarantee access and continuity of care.