Abbreviations: Experts selected risk factors for functional status decline based on four criteria: potential impact on functional impairment, strength of evidence, potential for risk reduction, and feasibility of assessment. The total bill for the shopping trip is automatically charged just like any other purchase on the customer’s Amazon account. No, Is the Subject Area "Primary care" applicable to this article? Similarly, many hospitals are also adopting real-time location systems to track the movement of people and equipment throughout their facilities.

Enrolment was terminated on January 8, 2002, when the required sample size was reached. The role of the health professionals in the intervention is summarised in Table 1. https://doi.org/10.1371/journal.pmed.1001889.t001. Sadly, many older people find that their enjoyment of life is curtailed by chronic illnesses and increasing disability.

The data for the general population is based on the Swiss National Cohort; mean age of the population was 74.8 ± 6.9 (SD) y, with 58.1% women in the census in 2000. The world’s population is getting older. If so, Amazon could find itself as an outsourced supplier of IT services to the delivery systems that are currently trying to do this integration on their own. The hazard ratio of death comparing intervention with control was 0.79 (95% CI 0.66–0.94, p = 0.009; based on Wald test from Cox regression model), and the number needed to receive the intervention to prevent one death was 21 (95% CI 12–79). A total of 4,115 patients aged 65 y and older were assessed for eligibility, 3,493 were eligible, and 2,284 were included in the study and underwent randomisation (Fig 1). Survival was analysed using Kaplan-Meier life table methods and Cox regression models, with time from the date of randomisation to the date of death or 31 December 2008, as the underlying timescale. Also, as the study was undertaken at a single site, these findings may not be generalizable. Also, most states recognize … At eight years, 77.9% and 72.8% of the participants in the intervention and control groups, respectively, were still alive. Get top apps, movies, books, TV, music and more on your new Android devices. While Amazon’s collaboration with Berkshire Hathaway and JPMorgan Chase would obviously leverage the purchasing power of three massive employers and could lead to innovative insurance models, it seems that the bigger opportunity would be in improving how care is delivered to patients. To enter and activate the submenu links, hit the down arrow.

The intervention tested in our study may serve as a model of how to implement a relatively low-cost but effective programme of disease prevention and health promotion in older individuals.

The study received funding from the European Union as part of the PRO-AGE (Prevention in Older People–Assessment in Generalists’ Practices) study and from regional foundations. Analyses were run on 25 imputation datasets, and the results were combined with Rubin’s rule [28]. Field tests among community-dwelling older individuals in the US, the UK, Germany, and Switzerland demonstrated the acceptance and feasibility of the HRA-O questionnaire [12–14,22]. From November 2000 to January 2002, 874 participants were randomly allocated to the intervention and 1,410 to usual care. For example, in the intervention group 70.1% of individuals reported being physically active on average at least 30 min per day compared to 62.1% in the control group. The two trials conducted in Hamburg and London were designed as short-term trials, and the final results of these trials (including effects on preventive care use and health behaviours at 1-y follow-up) have been published [12,13]. Our offices are located at 810 Vermont Ave., NW Washington D.C. 20420, + Required plugins [ Get Viewer Software ]. 2. Institute of Primary Care, University of Bern, Bern, Switzerland, Affiliation We used multiple imputation by chained equations assuming a missing-at-random situation [27]. The study methods and selected baseline findings of the present trial conducted in Solothurn have been previously published [14,15], and the detailed study protocol and analysis plan are available in S1 Text. Visit the Job Opportunities page to learn more about the exciting opportunities waiting for you at VA. A career at VA can offer the quality of work life balance you crave. Regionally adapted HRA-O approaches might reach large groups of older individuals at relatively low cost. Collecting such information can be onerous, requiring separate efforts that are often challenging to integrate. Designed the intervention: AES SB SI DH CS JCB. However, studies have found that HRA-based interventions were effective for intermediate outcomes only if older individuals received HRA combined with some form of personal reinforcement [7,8,11].

This is the first trial to our knowledge demonstrating that a collaborative care model of HRA in community-dwelling older people not only results in better health behaviours and increased use of recommended preventive care interventions, but also improves survival. Wrote the first draft of the manuscript: AES. Yes https://doi.org/10.1371/journal.pmed.1001889.s001, https://doi.org/10.1371/journal.pmed.1001889.s002, https://doi.org/10.1371/journal.pmed.1001889.s003, https://doi.org/10.1371/journal.pmed.1001889.s004, https://doi.org/10.1371/journal.pmed.1001889.s005, https://doi.org/10.1371/journal.pmed.1001889.s006, https://doi.org/10.1371/journal.pmed.1001889.s007, https://doi.org/10.1371/journal.pmed.1001889.s008, https://doi.org/10.1371/journal.pmed.1001889.s009, https://doi.org/10.1371/journal.pmed.1001889.s010, https://doi.org/10.1371/journal.pmed.1001889.s011, https://doi.org/10.1371/journal.pmed.1001889.s012, https://doi.org/10.1371/journal.pmed.1001889.s013, https://doi.org/10.1371/journal.pmed.1001889.s014, https://doi.org/10.1371/journal.pmed.1001889.s015, https://doi.org/10.1371/journal.pmed.1001889.s016, https://doi.org/10.1371/journal.pmed.1001889.s017, https://doi.org/10.1371/journal.pmed.1001889.s018, https://doi.org/10.1371/journal.pmed.1001889.s019. At baseline and 1-y follow-up, PCPs sent a HRA-O questionnaire to patients allocated to the intervention arm. The early detection and successful modification of risk factors for functional status decline identified with the HRA-based intervention and the improvement in recommended preventive care use likely explained this reduction in mortality.

While the capture of online data is a capability that Amazon has had since its inception, its recent move into cashier-less retailing with its Amazon Go store in Seattle offers a glimpse into the company’s potential for health care. At 8 y, based on an intention-to-treat analysis, the estimated proportion alive was 77.9% in the intervention and 72.8% in the control group, for an absolute mortality difference of 4.9% (95% CI 1.3%–8.5%, p = 0.009; based on z-test for risk difference). Originally developed for workforce health promotion, HRA is based on self-reports to guide risk factor interventions, with subsequent individualised feedback to participants on their health status and on how to promote health, maintain function, or prevent disease [9,10].

This HRA was combined with an electronic health record reminder system for use in the primary care practice setting, but it is not known to what extent these reminders were actually used for counselling [12]. Yes For example, one randomised controlled trial found that chronically ill older adults who were offered a community-based nurse intervention had a 25% lower risk of death as compared to control group individuals with usual care [4]. By clicking on these links, you will leave the Department of Veterans Affairs Website. VA-wide workforce data, In accordance with Public Law 115-182, the VA Mission Act of 2018, Section 505. Over the 8-y follow-up, the mortality rate was 3.16 (95% CI 2.74–3.63) per 100 person-years in the intervention group, as compared to 3.97 (95% CI 3.59–4.39) in the control group; the hazard ratio was 0.79 (95% CI 0.66–0.94, p = 0.009; based on Wald test from Cox regression model) (Fig 2). 3. The PCPs generated lists of all patients aged 65 y or older whom they had seen at least once over the past 5 y. Although multiple earlier studies have addressed intermediate outcomes of HRA-based interventions, a 2011 systematic analysis found no controlled study with long-term health outcomes of the effect of HRA on mortality or functional status in older individuals [8], and, to our knowledge, no new study of this type has been published since then. A Cox regression analysis including a treatment–subgroup interaction term revealed that there was no statistically significant interaction between group assignment (intervention versus control) and the two pre-specified subgroups (low and high baseline risk) (p = 0.32), demonstrating that the relative survival effects of the intervention did not differ between the low- and high-risk subgroups.