Journal of the American Medical Directors Association · 2026
Effectiveness of Family Physician-Led Home-Based Long-Term Care on Quality of Life in Older Adults With Disability: A Quasi-Experimental Study.
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Zhang Leyuan, Zhou Lifang, Lang Zihan, Yin Dahai, Zhang Haoyu, Liu Zhenhua, Wu Yixuan, Li Zhansheng, Yu Qianqian
Аннотация
OBJECTIVES: To evaluate the effects of a family physician-led home-based long-term care program on the quality of life of older adults with disability and to examine heterogeneity by disability level and sex.
DESIGN: Quasi-experimental study. The intervention group received twice-weekly home visits from family physician teams providing medication management, psychological counseling, rehabilitation guidance, and monthly health monitoring. The control group received routine quarterly follow-ups.
SETTING AND PARTICIPANTS: The study was conducted in 3 communities located in different districts of Weifang, Shandong Province, China, from December 2023 to December 2024. A total of 296 community-dwelling older adults aged ≥60 years with disability completed baseline and follow-up surveys.
METHODS: Propensity score matching was used to improve baseline comparability, and difference-in-differences models with clustered standard errors were used to assess intervention effects on 36-Item Short Form Health Survey domains and their heterogeneity.
RESULTS: In unadjusted comparisons, the intervention group showed greater improvements in quality-of-life outcomes, whereas the control group showed declines in mental health and vitality. In DID models, the intervention improved overall quality of life (β = 3.32; P = .033), mental health (β = 4.72; P = .013), and vitality (β = 3.85; P = .018). No statistically significant changes were observed in other domains. Effects were strongest among participants with severe disability and women, whereas no significant effects were observed in those with moderate disability or in men.
CONCLUSIONS AND IMPLICATIONS: This family physician-led home-based long-term care model was associated with modest improvements in psychological and overall quality-of-life outcomes among older adults living with disability. These findings highlight the potential of integrated, home-based care to enhance person-centered, stratified care (ie, tailored to disability level and care needs). Further research is needed to assess long-term outcomes, cost-effectiveness, and the robustness of subgroup differences.
DESIGN: Quasi-experimental study. The intervention group received twice-weekly home visits from family physician teams providing medication management, psychological counseling, rehabilitation guidance, and monthly health monitoring. The control group received routine quarterly follow-ups.
SETTING AND PARTICIPANTS: The study was conducted in 3 communities located in different districts of Weifang, Shandong Province, China, from December 2023 to December 2024. A total of 296 community-dwelling older adults aged ≥60 years with disability completed baseline and follow-up surveys.
METHODS: Propensity score matching was used to improve baseline comparability, and difference-in-differences models with clustered standard errors were used to assess intervention effects on 36-Item Short Form Health Survey domains and their heterogeneity.
RESULTS: In unadjusted comparisons, the intervention group showed greater improvements in quality-of-life outcomes, whereas the control group showed declines in mental health and vitality. In DID models, the intervention improved overall quality of life (β = 3.32; P = .033), mental health (β = 4.72; P = .013), and vitality (β = 3.85; P = .018). No statistically significant changes were observed in other domains. Effects were strongest among participants with severe disability and women, whereas no significant effects were observed in those with moderate disability or in men.
CONCLUSIONS AND IMPLICATIONS: This family physician-led home-based long-term care model was associated with modest improvements in psychological and overall quality-of-life outcomes among older adults living with disability. These findings highlight the potential of integrated, home-based care to enhance person-centered, stratified care (ie, tailored to disability level and care needs). Further research is needed to assess long-term outcomes, cost-effectiveness, and the robustness of subgroup differences.