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Coordinated care versus standard care in hospital admissions of people with chronic illness: a randomised controlled trial

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Chronic, non-communicable diseases including cardiovascular diseases, oral health care, mental disorders and musculoskeletal diseases comprised 85% of the total burden of illness in Australia and New Zealand in the 2008–09 financial year, incurring direct health care costs of $27 billion.1 Respiratory illness, heart disease and diabetes comprised 80% of the total burden of illness and injury and 70% of health expenditure in Australia in 2004.2,3

Fragmentation of health care with poor coordination and communication among care agencies and a lack of continuity of care are noted as problems.4 As a consequence, some consumers rely heavily on local hospital emergency departments (EDs) to provide ongoing care. Although Australian and overseas studies have emphasised coordination problems in the management of chronic care, little is known about what defines well coordinated care, and what comprises an effective program.57

Australian coordinated care experiments between 1997 and 20058 often ended up costing more than standard care, and fewer than half showed an improvement in patient wellbeing.8