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In 1995 we identified all people aged 65 and over
who were recipients of home health services or
home assistance programs (n 224). Usually,
patients were receiving these services because of
multiple geriatric conditions (for example,
dementia, immobility, incontinence, and stroke
deficits). The subjects were randomly stratified
by age and gender according to a computer
generated list.
BMJ 19983161348-51
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Rovereto Model
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Rovereto Project

• One hundred subjects (control group) received
  primary and community care with the conventional
  and fragmented organisation of services (i.e.,
  general practitioner's regular ambulatory and
  home visits, nursing and social services, home
  aids, and meals-on-wheels).
• Another hundred subjects (intervention group)
  received case management and care planning by the
  community geriatric evaluation unit and general
  practitioners. All the services considered
  necessary were provided in an integrated fashion
  after a formal agreement between Municipality and
  the local Health Agency. Twenty-one of 24 general
  practitioners agreed to participate in the trial
  and to be involved in care planning and meetings.

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At baseline, subjects in the intervention and
control groups did not show statistically
significant differences across several functional
and clinical variables
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In the CG, all functional scores deteriorated
(ADL -13.0 IADL -6.9 SPMSQ - 9.4 GDS
-11.8). In the IG, less consistent changes
were observed ADL score slightly improved
(5.1) while IADL's remained unchanged SPMSQ
and GDS scores declined slightly. Differences
between IG and CG were all significant.
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• Thirty-six percent of subjects in the
  intervention group and 51 of those in the
  control group were admitted at least once to
  acute hospital (plt0.05).
• Patients in the control group had a trend toward
  higher admission to nursing home. The cumulative
  number of days/year spent in either nursing home
  (1087 vs. 2121) or acute hospital (894 vs. 1376)
  was reduced almost halved in the intervention
  group.

The benefit obtained in the intervention group
was achieved without increases in use of health
services. Indeed, home support (154
hours/patient/year in control group vs. 120 in
intervention group), nursing care (12
hours/patient/year vs. 13) and meals on wheels
(39 meals/patient/year vs. 54) services did not
differ.
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Results of survival analyses based upon time to
either first hospital or nursing home admission
IG accounted for 23 less total per capital
health care costs than CG.
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Four Health Care Agencies PIEVE DI SOLIGO,
ZOGNO, TERNI, LECCE 704 women and 500 men
J Clin Epidemiol 200154968-70
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Following the implementation of the integrated
home care program, there was a significant
reduction of the number of hospitalizations (26
vs. 44, P 0.001) associated with a reduction of
hospital days at the individual patient level and
for each admission. Furthermore, when we excluded
from the analyses the patients who died and the
patients admitted to the home care program
directly after a discharge from hospital, a
significant reduction in the hospital use and in
the number of days spent in hospital was
observed. This resulted in a 27 cost reduction
in the intervention group.