gms | German Medical Science

Background: The demographic development and the resulting increasing geriatric needs for care will be one of the biggest societal challenges in the next decade. The German health care system is characterized by a strong sectoring and fragmentation of service provision. Health problems of geriatric patients, however, are frequently multi-faced and complex and overlaid or influenced by social living conditions. Due to the lack of cross-sectoral and interprofessional care, the geriatric patient is often not adequately supplied. Only a multi-dimensional perspective allows a holistic assessment of the health risks, but also the health potential and the factors of health maintenance. By implementing a cross-divisional, multi-professional, assessment-based case management, the care-gaps could be reduced and geriatric patient’s autonomy can be preserved as long as possible.

Objective: Our subproject of the RubiN-study refers to the quantitative evaluation with primary data from (geriatric) assessments. Generally, the RubiN-project (regional uninterrupted care in the network) investigates the effect of multi-professional, cross-sectoral and assessment-based case management on the quality of geriatric care. The primary study objective assesses whether the care of geriatric patients can be improved by using accredited practice networks containing no gaps between care levels and sector boundaries, thus improving the standard care for these patients. Furthermore, the RubiN-project analyses the reduction in burden, support and satisfaction of relatives of geriatric patients through the implementation of the case management.

Methods: The project will be evaluated by a prospective controlled design that compares practice networks in different regions of Germany. The intervention is carried out in five practice networks, three practice networks serve as the control group. In the interventional group, 3,200 patients will be included, in the control group a total of 1,200 patients. The evaluation of our subproject occurs at the levels of geriatric patients and their relatives. The primary endpoint are everyday activities, measured using Barthel Index. At first, all patients’ ≥70 years are screened with the Angelina-Screening in the GP-practices. Patients who fulfill the inclusion criteria receive the comprehensive baseline-assessment consisting of nine questionnaires to assess sociodemographic factors, quality of life, malnutrition, social support and economic parameters. Patients in the intervention networks receive geriatric case management (the intensity depends on the level of severity) and patients in the control networks care as usual. The follow-up assessment is conducted 12 months after baseline. The patient-related data is collected by the e-CRF-supported CentraXX documentation system of the Institute for Community Medicine and stored in project databases of the institute.

Results: Due to the current project status (recruitment-phase), no results are available yet.

Discussion: The implementation of a cross-sectoral and cross-professional geriatric case management has been discussed for years, while the positive effect has long been proven. Most are financial barriers that allow for final implementation. Within GP-centered care, alternatives were developed, often with nurses or physician assistants (e.g. AGnES). The boundaries to a classic case management can thereby be fluent depending on how well positioned the practice is. Consequently, there might be large differences in care of geriatric patients. The evaluation of traditional case management versus “care as usual” thus depends on current practice standards and their interpretation of good geriatric care and, in addition, on their financial scope. It is undisputed that the concept of geriatric case management is effective, but to evaluate this positively it depends on the present geriatric care of the control group and how they interpret “care as usual”.

Practical implications: The current care of geriatric patients is not optimal, as the available resources are not sufficiently used. The aim of the RubiN project is to show, if the supply of this sensitive patient group is improved by an implemented geriatric case management – with respect to the individual and to the health economic level.