Core inputs | Immediate Impacts | Short-Term Impacts | Impacts | Outcomes |
---|---|---|---|---|
Geriatric assessment at emergency department, | Contact between emergency department and municipality case manager | Municipality care will have increased information regarding the needs of the older person, | Possibilities for earlier discovery of problems, | Maintained functional ability, |
Case manager and multi-professional team at the municipality care, | Increased contact between case manager and hospital ward | Increased contact between emergency healthcare and municipality social care, | Earlier care and rehabilitation efforts and changes in care and rehabilitation plans, | Increased life satisfaction, |
Care planning after hospital discharge at older person's home | Case manager has early contact with older person at hospital, | Older people have more knowledge of whom to contact when they need help, | Better uptake of older people's viewpoints | Reduced number of visits to the emergency department, |
 | Case manager has early contact with older peoples' families, | Increased participation opportunities for older people and their families in care planning |  | Reduced number of stays in hospital wards, |
 | Continuous contact between case manager and older people |  |  | Higher satisfaction with municipality care and rehabilitation |