Evidence map›Paper›PMID 26764392›Full record

Trial reportAge and ageing2016

Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study.

Jeanet Blom, Wendy den Elzen, Anne H van Houwelingen, Margot Heijmans, Theo Stijnen, Wilbert Van den Hout, Jacobijn Gussekloo

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Age and ageing, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
70citing papers in PubMed, 12 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

70 citing papers in PubMed, 12 syntheses or guidelines pooled it.

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  7. Cost and effects of integrated care: a systematic literature review and meta-analysis.The European journal of health economics : HEPAC : health economics in prevention and care · 2020
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10 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jeanet BlomPublic Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
Wendy den ElzenPublic Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
Anne H van HouwelingenPublic Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
Margot HeijmansPublic Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
Theo StijnenDepartment of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.
Wilbert Van den HoutDepartment of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Jacobijn GusseklooPublic Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundolder people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established.

designcluster randomised trial.

participantsall persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains.

interventionfor participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. OUTCOME MEASURES: (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up.

trial registrationNetherlands trial register, NTR1946.

resultsof the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care.

conclusionsGPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons.

Indexed as

Health Care CostsModels, OrganizationalActivities of Daily LivingAgedAged, 80 and overAge FactorsCost-Benefit AnalysisDelivery of Health Care, IntegratedFeasibility StudiesFemaleGeneral PracticeGeriatric AssessmentHealth Services for the AgedHealth Services ResearchHumansMaleagedintegrated careolder peopleprimary careproactive care

Identifiers

PMID26764392
PMCPMC4711660

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.