Embrace, a model for integrated elderly care:a randomized controlled trial on the effectiveness regarding quality of care, service use and costs

Summary:

Embrace (“SamenOud” in Dutch) is a population-based integrated care model based on theChronic Care Model and the Kaiser Permanente Triangle. The essence of Embrace is the integrationof the various policies, approaches, and resources present in the care for elderly people. By meansof annual screening and triage, elderly people aged 75 years and older are assigned to one of threerisk profiles (robust, frail, or complex care needs) with corresponding care and support intensitylevels. Next, a multi-disciplinary Elderly Care Team offers appropriate personalized, pro-active,and preventive care and support. A randomized controlled trial was performed to determine theeffectiveness of Embrace. Expected outcomes are that Embrace improves patient outcomes andquality of care, and reduces service use and costs. Two qualitative studies among participants andcase managers already show positive results.