Evaluating a Model of Service Integration for Older People with Complex Health Needs

Background Older people with multiple chronic conditions and complex health care needs require a comprehensive, accessible and well-coordinated system of services. To address this growing problem, a consortium of acute and community-based health care organisations implemented a ‘Patients First’ model of service integration for the target population. The project evaluation utilised a combination of quantitative and qualitative methods in an action research framework. Findings The evaluation process not only demonstrated the benefits of the project to patients and the health care system, but also contributed to the identification of pivotal components in the model, aspects requiring attention and consequently their refinement. It was also a vehicle for the development of a sense of ownership amongst staff and has evolved into an integral part of the model.