© 1998 Evidence-Based Mental Health
Integration of medical and social services for elderly people in the community reduced costs and use of health services
Bernabei R, Landi F, Gambassi G, et al. Randomised trial of impact of model of integrated care and case management for older people living in the community.BMJ 1998 May 2;316:1348–51
Question In frail, elderly people living in the community, does the integration of medical and social services with case management programmes reduce functional decline, admissions to institutions, and the use and costs of health services?
1 year randomised controlled trial.
A town (Rovereto) in northern Italy.
200 adults (mean age 81 y, 71% women) who were 
65 years of age and received home health services or home assistance programmes.
Patients were allocated to integrated care (ie, general practitioners [GPs], and a community geriatric evaluation unit used case management and care planning to integrate the provision of social and medical services) (n=100) or standard care (n=100), which included GP ambulatory and home visits, nursing and social services, home aids, and meals on wheels.
Physical and cognitive function, admission to an institution, and use and costs of health services.
After results were adjusted for baseline values (ie, sex, marital status, living alone, financial status, physical and cognitive function, medical conditions, and medications used), integrated care led to better functional outcomes than did standard care (Activities of Daily Living [ADL] adjusted mean score 2.0 v 2.6, p<0.001; Instrumental
University of East Anglia Norwich, UK
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