Person-centered, cross organizational and multiprofessional team halves mortality risk. The PAtient Centered Care Team (PACT) Study – Preliminary results from a comparative effectiveness study

Introduction: Patients with multi-morbidity and complex care-needs typically face multiple care processes, care providers, organizations and specialties over longer periods1. Fragmented care is not only a source of human suffering; it also drives health care costs for this patient group.Theory and Methods: The PACT project is directed at frail multi-morbid patients with increased risk for emergency hospitalization or re-admission. It is an integrated, multi-professional intervention bridging primary and secondary care while emphasizing a 1) person-centered 2) holistic and 3) proactive approach2.This is a propensity score matched controlled comparison of PACT versus usual care using routine data from the specialist electronic health care record: age, gender, diagnosis codes (ICD10), episodes of health service utilization. Eligibility criteria were patients >=60 years, referred to and treated by the PACT team (intervention) or an emergency admission in a somatic secondary care ward at the Univ hospital of Northern Norway (controls, approx. 10 500 episodes) in 2015. Primary outcome: inpatient emergency days (InPtEmergDays) in secondary care at 6 months follow-up from start and 6 months from stop of intervention. Secondary: 6-month mortality risk. The propensity score (PS) and Mahalanobis distance (MD) was based on 17 and 3 pre-intervention variables respectively. Control PS had to be within a +/- 0,2 SD caliper of intervention PS to be eligible. Within calipers, we chose the match with closest MD. Poisson and Cox regression was used to calculate adjusted risk ratios (RR) between groups.Results:Of 272 PACT episodes of care we excluded 39 (not eligibile), 28 (lacking pre-intervention data) and 22 (no suitable match) leaving 183 PACT episodes, in 177 PACT patients, matched to 183 unique controls. We achieved excellent pre-intervention balance between groups according to Rubin’s criteria3. Participant description: 34% male, average 80 years, 5 long-term ICD-10 diagnoses last year, 4 inpatient emergency days last 30 days prior to intervention.Primary outcome: PACT patients enjoyed a 30% reduction (p