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South Winnipeg Integrated Geriatric Program (SWING): A Rapid Community-Response Program for the Frail Elderly*

Published online by Cambridge University Press:  31 March 2010

Patrick R. Montgomery  and
Wendy M. Fallis
Patrick R. Montgomery*
Affiliation:
University of Manitoba
Wendy M. Fallis
Affiliation:
St. Boniface General Hospital, Winnipeg
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Patrick R. Montgomery, M.D., F.R.C.P.(C)., Department of Geriatric Medicine, E4003 St. Boniface General Hospital, 409 Tache Ave, Winnipeg, MB R2H 2A6. (pmontgom@mail.sbgh.mb.ca)
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Abstract

The objective of this study was to compare enhanced access to geriatric assessment and case management to usual home care service provision for the frail elderly. This was a demonstration project, with randomized allocation to control or intervention groups of frail elderly persons who had been referred to the Home Care service in Winnipeg. Of the 164 persons who were randomized, 78 intervention and 74 control patients were evaluated. Intervention subjects received a multidimensional assessment as soon as possible by a specially trained coordinator, who had enhanced access to geriatric medical and day-hospital services; intervention patients were case managed for a 3-month period. Control cases received usual care from home care coordinators. The intervention group received significantly faster assessment and deployment of home services, as well as greater utilization of the geriatric day-hospital services. Utilization of emergency room and hospital services was similar for both groups. Control subjects experienced more prolonged hospital stays and a significantly higher proportion (23%) were designated for long-term care than of intervention clients (9%). We conclude that the SWING program, which facilitated access to geriatric services and case management, reduced or delayed the need for long-term care.

Résumé

La présente étude a pour objectif de comparer l'incidence d'un accès amélioré à des services d'évaluation et de gestion de cas en gériatrie à la prestation habituelle de services de soins à domicile aux personnes âgées de santé fragile. Il s'agit d'un projet de démonstration au cours duquel des personnes âgées de santé fragile mises en rapport avec le service administrant les soins à domicile à Winnipeg ont été réparties au hasard parmi des groupes d'intervention et de contrôle. Des 164 personnes choisies au hasard, 78 patients du groupe d'intervention et 74 patients du groupe de contrôle ont été évalués. Les patients du groupe d'intervention ont été soumis, dès que possible, à une évaluation multidimensionnelle menée par un coordonnateur dûment formé ayant un meilleur accès aux services médicaux et d'hôpital de jour en gériatrie; les patients du groupe d'intervention ont fait l'objet d'un processus de gestion de cas pendant une période de trois mois. Le groupe de contrôle a reçu les soins habituels de la part des coordonnateurs des soins à domicile, tandis que le groupe d'intervention a bénéficié de services d'évaluation et de soins à domicile beaucoup plus rapides ainsi que d'un accès accru aux services de l'hôpital de jour en gériatrie. L'utilisation de la salle d'urgence et des services hospitaliers était semblable dans les deux cas. Les membres du groupe de contrôle ont effectué des séjours à l'hôpital plus longs et une proportion beaucoup plus importante d'entre eux (23 %) ont été retenus pour la prestation de soins à long terme que dans le cas du groupe d'intervention (9 %). On peut conclure que le programme SWING, qui a facilité l'accès aux services de gériatrie et de gestion des cas, a réduit ou a repoussé le besoin de soins à long terme chez les patients.

Keywords

agingcase managementmultidisciplinary careday hospitalhome carerandomized controlled designfrail elderlyvieillissementgestion des cassoins multidisciplinaireshôpital de joursoins à domicileétude sur échantillon aléatoire et contrôlépersonnes âgées de santé fragil
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 22 , Issue 3 , Fall/Automne 2003 , pp. 275 - 281
Copyright
Copyright © Canadian Association on Gerontology 2003

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Footnotes

*

The authors gratefully acknowledge the Healthy Communities Development Fund, Manitoba Health, for providing financial support for this study. Sharon Campbell, R.N., B.N. and Deborah Chochinov R.N., B.N. are to be acknowledged for their assistance with data collection and abstraction respectively. Statistical analysis was undertaken by Judy Chipperfield, Ph.D., University of Manitoba. The authors also are grateful for the assistance of the members of the SWING committee: Heather Carlsson-Reid R.N., B.N. (Project Manager), Pat Johnson, B.N., M.Ed., Jean Burton, R.N., B.Sc.N., Patty Hrychuk, R.N., Susan Fallowfield, R.N., B.N., and Joanne Schrof, R.N., B.N.

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