• Atef H. Khatib Istishari Arab Hospitala. & Al Quds University Public health institute. Ramallah, West Bank.
  • Ayman M. Hamdan- Mansour Faculty of Nursing-Al Ahliyya Amman University, & School of Nursing-The University of Jordan Amman - Jordan
  • Hamza F. Ratrout College of Nursing- King Saud University. Riyadh, Saudi Arabia
  • Atallah Alenezi College of Nursing- Shaqra University. Shaqra-Saudi Arabia
  • Tala R. Chahien Global Health Development & Eastern Mediterranean, Public Health Network (EMPHNET). Amman – Jordan
Keywords: Elderlies, Elderly care, Quality of care, Health Care Outcomes, Integrated Elderly Care, West Bank


The rapid increase in the ageing population and health conditions are imposing a higher challenge to the health care system that requires multidisciplinary teamwork utilizing coordinated care approach. This study examined the effects of integrated care model on quality of care received by older hospitalized patients in West Bank. A quantitative interrupted time series design (pretest and posttest multiple time series, quasi-experiment design) was used. The study examined the effects of integrated care model on admitted older patients (n=32) in the West Bank measuring ten dimensions of quality of care and four health indicators. There was a significant improvement in the dimensions of quality of care: dimensions: nurses’ communications with patients, physicians’ communications with patients, staff response to patients’ needs, pain management, explanations on medications, amount of information given on discharge plan, patients' area cleanliness, patients' area quietness, rating of the hospital, and willingness to recommend the hospital. Incidence of falls and incidence of pressure ulcer improved after implementing the model, while readmission rate and average length of stay did not improve. This study contributed to the limited body of knowledge related to the effect of integrated care model on hospitalized older patients’ quality of care in Palestine/ West Bank. Integrated care has the potential to improve care outcomes among hospitalized older patients.


1. Abyad A, Al-Baho AK, Unluoglu I, Tarawneh M, Hilfy TK. Development of family medicine in the Middle East. Family Medicine-Kansas City- 2007; 39(10):736.

2. National Institutes of Health. World’s older population grows dramatically. US Department of Health & Human Services. 2016.

3. United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing (ST/ESA/SER. A/348). 2013.

4. World Health Organization. World health statistics 2015. World Health Organization; 2015.

5. Hamdan-Mansour A. Sociodemographic correlates of somatic symptoms of older persons in Jordan. Jordan Med J 2007; 51 (3): 119-30.

6. Sieber CC. Der ältere Patient–wer ist das? Der Internist 2007; 48(11), 1190-4.

7. Kinsella K, He W. US Census Bureau, international population reports. Washington, DC: US Census Bureau. 2009.

8. Dijkstra A, Hakverdioğlu G, Muszalik M, et al. Health related quality of life and care dependency among elderly hospital patients: an international comparison. Tohoku J Exp Med 2015; 235(3):193-200.

9. Wang Q, Suo J, Jiang J, et al. Effectiveness of fast‐track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis 2012; 14(8):1009-13.

10. Doumit J, Nasser R. Elderly residents in Lebanese nursing homes: Quality of life and wellbeing. International Journal of Health Care Quality Assurance 2010; 12;23(1):72-93.

11. Hamdan-Mansour A, Shehadeh J, Puskar K, ET AL. Investigating physical, psychological and social wellbeing of older persons in Jordan. Curr Aging Sci 2017; 10(3),217-23. DOI 10.2174/1874609810666170113093307

12. Al Khatib A, Hamdan-Mansour A, BaniHani M. Theoretical perspectives of hospitalized older patients and their health related problems and quality of care: Systematic Literature Review. The Open Public Health Journal 2017; 10, 215-25.

13. Spinewine A, Swine C, Dhillon S, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc 2007; 55(5):658-65.

14. Kodner DL, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications–a discussion paper. International journal of integrated care. 2002 Oct;2.

15. Bernabei R, Landi F, Gambassi G, et al. Randomized trial of impact of model of integrated care and case management for older people living in the community. BMJ 1998; 2;316(7141):1348.

16. Dreidi H, Hamdan-Mansour A. Pain, Sleep Disturbance, and Quality of Life Among Palestinian Patients Diagnosed with Cancer. J Cancer Edu 2016; 31 (4), 796–803.

17. Hamdan‐Mansour A. Predictors of hostility among university students in Jordan. Scand J Caring Sci 2010; 24(1):125-30.

18. Wahlbeck K, Manderbacka K, Vuorenkoski L, et al. Quality and equality of access to healthcare services. Health QUEST country report for Finland. Helsinki: National Research and Development Centre for Welfare and Health (STAKES). 2008 Mar.

19. Lopez-Garcia E, Banegas JB, Gutierrez-Fisac JL, et al. Relation between body weight and health-related quality of life among the elderly in Spain. Int J Obes 2003; 27(6):701.

20. Sung KT. Elder respect: Exploration of ideals and forms in East Asia. J Aging Stud 2001; 1;15(1):13-26.

21. Robinson A, Cubit K. Caring for older people with dementia in residential care: nursing students’ experiences. J Adv Nurs 2007; 59(3):255-63.

22. Houttekier D, Cohen J, Surkyn J, et al. Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes. BMC Public health 2011; 11(1):228.

23. Hébert R, Durand PJ, Dubuc N, et al. PRISMA Group. PRISMA: a new model of integrated service delivery for the frail older people in Canada. Int J Integr care 2003; 3: e08.

24. Alanazi MR, Alamry A, Al-Surimi K. Validation and adaptation of the hospital consumer assessment of healthcare providers and systems in Arabic context: Evidence from Saudi Arabia. J Infect Public health 2017; 1;10(6):861-5.

25. Centers for Medicare & Medicaid Services. The HCAHPS survey—frequently asked questions. Available at:) (Published 2013, Accessed February 8, 2017) https://www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/HospitalHCAHPSFactSheet201007. pdf View in Article. 2015.

26. Jadotte YT, Chase SM, Qureshi RI, et al. The HCAHPS Survey as a Potential Tool for Measuring Organizational Interprofessional Competency at American Hospitals Nationwide: A Content Analysis Study of Concept Validity. Health Interprof Practice 2017;3(2):1.

27. Hébert R, Raîche M, Dubois MF, et al. Prisma Group. Impact of PRISMA, a coordination-type integrated service delivery system for frail older people in Quebec (Canada): A quasi-experimental study. Gerontol B Psychol Sci Soc Sci 2009; 4;65(1):107-18

28. Janse B, Huijsman R, Fabbricotti IN. A quasi-experimental study of the effects of an integrated care intervention for the frail elderly on informal caregivers’ satisfaction with care and support. BMC Health Serv Res 2014; 14(1):140.

29. Chumbler NR, Otani K, Desai SP, Herrmann PA, Kurz RS. Hospitalized older adults’ patient satisfaction: Inpatient care experiences. Sage Open. 2016 Apr 20;6(2):2158244016645639.

30. Bogner HR, de Vries McClintock HF, Hennessy S, et al. Patient satisfaction and perceived quality of care among older adults according to activity limitation stages. Arch Phys Med Rehabil 2015; 96(10):1810-9.

31. Darawad M, Hammad S, Mosleh S, et al. Psychosocial correlates of diabetes self-management practices. Iran J Public Health 2017; 46(6), 771-781.

32. Riviere M, Dufoort H, Van Hecke A, et al. Core elements of the interpersonal care relationship between nurses and older patients without cognitive impairment during their stay at the hospital: A mixed-methods systematic review. Int J Nurs Stud 2019; 92:154-72.

33. Janse B, Huijsman R, de Kuyper RD, et al. The effects of an integrated care intervention for the frail elderly on informal caregivers: a quasi-experimental study. BMC Geriatr 2014;14(1):58.

34. Otani K, Herrmann PA, Kurz RS. Improving patient satisfaction in hospital care settings. Health Serv Manag Res 2011;24(4):163-9.

35. Ravindran RM, Kutty VR. Risk factors for fall-related injuries leading to hospitalization among community-dwelling older persons: a hospital-based case-control study in Thiruvananthapuram, Kerala, India. Asia Pac J Public Health 2016;28(1):70S-6S.

36. Jaul E, Calderon‐Margalit R. Systemic factors and mortality in elderly patients with pressure ulcers. Int Wound J 2015;12(3):254-9.

37. Baumgarten M, Margolis DJ, Localio AR, et al. Extrinsic risk factors for pressure ulcers early in the hospital stay: a nested case–control study. J Gerontol A Biol Sci Med Sci 2008;63(4):408-13.

38. Koh SS, Manias E, Hutchinson AM, et al. Fall incidence and fall prevention practices at acute care hospitals in Singapore: a retrospective audit. J Eval Clin Pract 2007;13(5):722-7.

39. Reiter-Palmon R, Kennel V, Allen J, et al. Good catch! using interdisciplinary teams and team reflexivity to improve patient safety. Group Organ Manag 2018;43(3):414-39.

40. Bottle A, Middleton S, Kalkman CJ, et al. Global comparators project: international comparison of hospital outcomes using administrative data. Health Serv Res 2013;48(6pt1):2081-100.

41. Lingsma HF, Bottle A, Middleton S, et al. Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database. BMC Health Serv Res 2018;18(1):116.
How to Cite
Atef H. Khatib, Ayman M. Hamdan- Mansour, Hamza F. Ratrout, Atallah Alenezi, & Tala R. Chahien. (2020). TESTING THE EFFECTIVENESS OF INTEGRATED ELDERLY CARE MODEL ON QUALITY OF CARE AND HEALTH OUTCOMES AMONG HOSPITALIZED ELDERLIES IN WEST BANK. Malaysian Journal of Public Health Medicine, 20(1), 82-89. https://doi.org/10.37268/mjphm/vol.20/no.1/art.559