"The PACE Evaluation": Two Responses

Coulam, Robert F.; Zimmerman, Yvonne A.; Clauser, Steven B.; Kidder, David; Mauser, Elizabeth

doi:10.1093/geront/36.1.7

Cited by 4 publications

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“… 20 Branch [ 64 ] suggests that the sites initially studied as part of the federal evaluation of the program may have selected less frail and lighter care patients than intended by the model. Clauser et al [ 65 ] refutes this claim. …”

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confidence: 99%

Fully integrated care for frail elderly: two American models

Kodner¹,

Kyriacou²

2000

Int J Integr Care

166

149

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PurposeIntegrated care for the frail elderly and other populations with complex, chronic, disabling conditions has taken centre stage among policymakers, planners and providers in the United States and other countries. There is a growing belief that integrated care strategies offer the potential to improve service co-ordination, quality outcomes, and efficiency. Therefore, it is critical to have a conceptual understanding of the meaning of integrated care and its various organisational models, as well as practical examples of how such models work. This article examines so-called “fully integrated” models of care in detail, concentrating on two major, well-established American programs, the social health maintenance organisation and the program of all-inclusive care for the elderly.TheoryA major challenge to understanding the performance and outcomes of fully integrated care and other organisational models is the lack of a meaningful, analytical paradigm. This article builds upon the work of Walter Leutz, to develop a framework by which new and existing programs can be analysed. This framework is then applied to the two American models that are the focus of this article.MethodsExisting data about integrated care in general, and the two model programs in particular, were collected and analysed from reports published by governmental and non-governmental organisations, and journal articles retrieved from Medline, HealthStar and other sources.Results and conclusionsThis analysis strongly suggests that fully integrated models of care, such as the social health maintenance organisation and program of all-inclusive care for the elderly, are not only feasible, but offer significant potential to improve the delivery of health and social care for frail elderly patients. In addition, the authors identify the factors that are the most critical to the success of fully integrated care, and offer lessons for their development and implementation. Finally, issues are raised concerning the transferability of this complex model to other countries, as well as the vital importance of evidence-based evaluation research in furthering the evolution of integrated care.

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confidence: 99%

Fully integrated care for frail elderly: two American models

Kodner¹,

Kyriacou²

2000

Int J Integr Care

166

149

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“…In two articles, the studies suffered from methodological bias 32 and changes in the country’s legislation during the period analyzed, 16 compromising the reliability of the results. Clauser et al 11 (1995) outline final considerations regarding the PACE model.…”

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confidence: 99%

Integração e continuidade do cuidado em modelos de rede de atenção à saúde para idosos frágeis

et al. 2014

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A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.

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“…(2) A single capitated fund or budget, in which all sources of support are pooled‐typically Medicare, Medicaid, and some private pay ‐ensures that the program staff can make and finance care plans, with emphasis on preventive and rehabilitative therapies, in relation to participants' changing needs. (3) As was so clearly true in the original On Lok, there is highly qualified and committed leadership.…”

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confidence: 89%

“…As in any capitation‐funded system, there is the possible risk of selecting enrollees who need lesser amounts of care and, therefore, less costly care, i.e., “skimming.” This question was raised in the 1992 evaluation by Branch et al 2 and contradicted in subsequent letters to the editor, 3, 4 with a response by Branch 5 . In my observations, the PACE programs respond to need for major skilled and supervised long‐term care for very frail individuals, clearly eligible for skilled nursing home care, who may be in hospital awaiting unavailable nursing home beds or at home receiving fragmented and insufficent care.…”

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confidence: 98%

PACE: A Continuing Evolving Success

Williams

1997

J American Geriatrics Society

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"The PACE Evaluation": Two Responses

Cited by 4 publications

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Fully integrated care for frail elderly: two American models

Fully integrated care for frail elderly: two American models

Integração e continuidade do cuidado em modelos de rede de atenção à saúde para idosos frágeis

PACE: A Continuing Evolving Success

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