Impact of a new assessment system, the MDS-HC, on function and hospitalization of homebound older people:: A controlled clinical trial

OBJECTIVES: To evaluate the impact of a new assessment system, the Minimum Data Set for Home Care (MDS-HC), on the functional status and hospitalization rates of frail, community-dwelling older people. DESIGN: Single-blind randomized trial with 1-year follow-up. SETTING: Bergamo, Italy. PARTICIPANTS: All 187 subjects who were eligible for home care services delivered by two Health Districts between September 1998 and April 1999. INTERVENTION: Random allocation to an intervention group undergoing MDS-HC assessment or to a control group receiving conventional geriatric assessment with Barthel, Lawton and Brody, and Mini-Mental State Examination (MMSE) scales. MEASUREMENTS: Hospitalization, health services use and costs, and variations in functional status. RESULTS: Survival analysis indicated that the intervention group was admitted to the hospital later and less often than were controls (relative risk = 0.49, 95% confidence interval = 0.56-0.97). Health services were used to the same extent, but intervention subjects used more in-home help services. Total costs for the intervention group were 21% lower than for the control group. The adjusted mean scores of the activities of daily living index (51.7 +/- 36.1 vs 46.3 +/- 33.7; P = .05) and MMSE (19.9 +/- 8.9 vs 19.2 10.7; P = .03) were significantly improved in the intervention group as compared with the control group. CONCLUSIONS: The MDS-HC assessment instrument may provide a cost-saving approach to reducing institutionalization and functional decline in older people living in the community.