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Multidimensional Geriatric Assessment: Back to the Future Effects on Health Care Use and Associated Cost of a Home Visiting Program for Older People With Poor Health Status: A Randomized Clinical Trial in the Netherlands

Departments of ¹ Epidemiology, ² School for Public Health and Primary Care (Caphri), ³ Health Organization Policy and Economics, ⁴ Methodology and Statistics, and ⁵ General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.

Address correspondence to Ans Bouman, MSc, Maastricht University, Department of Epidemiology, PO Box 616, 6200 MD Maastricht, the Netherlands. E-mail: ans.nicolaides{at}epid.unimaas.nl

Background. Home visiting programs have been developed to improve the functional abilities of older people and subsequently to reduce the use of institutional care services. The results of trials have been inconsistent and their cost-effectiveness uncertain. Home visits for a high-risk population rather than the general population seems a promising approach. We therefore studied the effects of a home visiting program for older people with poor health. This article describes the effects on health care use and associated cost.

Methods. We conducted a randomized clinical trial among 330 community-dwelling citizens, aged 70–84 years, in the Netherlands. Participants in the intervention group (n = 160) received eight home visits by a trained home nurse over an 18-month period; a multidimensional geriatric assessment of problems was included. The main outcomes are: admissions to hospital, nursing home, and home for older persons; contacts with medical specialists, general practitioners, and paramedics; and hours of home care help. The data on health care use were mostly obtained from computerized databases of various medical administration offices; the follow-up period was 24 months.

Results. Inpatient and outpatient health care use was similar for both groups, with the exception of a higher distribution of aids and in-home modifications in favor of the intervention group. No differences were found between the intervention and control group in health care cost.

Conclusion. The home visiting program did not appear to have any effect on the health care use of older people with poor health and had a low chance of being cost-effective. We conclude that these visits are probably not beneficial for such persons within the health care setting in the Netherlands or comparable settings in other Western countries.

Key Words: Community health care • Home visits • Frail adults • Multidimensional geriatric assessment and follow-up • Health care use • Cost and cost-analysis

This article has been cited by other articles:

				A. Huss, A. E. Stuck, L. Z. Rubenstein, M. Egger, and K. M. Clough-Gorr Multidimensional Geriatric Assessment: Back to the Future Multidimensional Preventive Home Visit Programs for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2008; 63(3): 298 - 307. [Abstract] [Full Text] [PDF]