Background Population aging has increased the prevalence of multimorbidity, jeopardizing the sustainability and efficiency of healthcare systems. This study aimed to evaluate the effects of an integrated ambulatory care program (IACP) on healthcare utilization and costs among older patients with multimorbidity while accounting for the confounding effects of frailty. Methods A retrospective cohort study using propensity matching including patients aged 65 or older with two or more chronic conditions attending the outpatient clinic at our hospital between June 1 and December 31, 2019, was conducted. Exposure was defined as receipt of IACP care. Patients not undergoing the IACP comprised the unexposed group and were matched at a ratio of 1:4 to patients undergoing the IACP group according to sex, age, Charlson Comorbidity Index score, multimorbidity frailty index score, and number of outpatient visits within 6 months before the index date. Outcomes were changes in healthcare utilization and related costs between 6 months before and after receiving IACP care. Multivariate regression analyses were used for data analysis and the Generalized Estimation Equation method was used to fit the regression models. Results A total of 166 (IACP) and 664 (non-exposed) patients were analyzed. The mean participant baseline ages were 77.15 ± 7.77 (IACP) and 77.28 ± 7.90 years (unexposed). In univariate analyses, the IACP group demonstrated greater reductions than the unexposed group in the frequency of outpatient visits (-3.16 vs. -1.36, p < 0.001), number of physicians visited (-0.99 vs. -0.17, p < 0.001), diagnostic fees (-1300 New Taiwan Dollar [NTD] vs. -520 NTD, p < 0.001), drug prescription fees (-250 NTD vs. -70 NTD, p < 0.001), and examination fees (-1620 NTD vs. -700 NTD, p = 0.014). Multivariate analyses demonstrated that patients in the IACP group experienced significant reduction in the frequency of outpatient visits (95% CI: -0.357 to -0.181, p < 0.001), number of physicians visited (95% CI: -0.334 to -0.199, p < 0.001), and overall outpatient costs (95% CI: -0.082 to -0.011, p = 0.01). However, emergency department utilization, hospitalization, and costs did not differ significantly. Conclusions Expanding IACPs may help patients with multimorbidity reduce their use of outpatient clinics at the 6-month follow-up, reduce care fragmentation, and promote sustainability of the healthcare system.

Background: Using multiple interventions can increase muscle strength in older adults. A functional fitness test is a useful instrument to identify the effectiveness of physical functioning among older adults. However, the results in previous studies with regard to improvements in their physical function are inconsistent. Aim: To synthesize the intensity and interval of the effective interventions on physical functioning in community-dwelling older adults. Methods: A systematic review and meta-analysis on the related literature was conducted. The databases searched were PubMed, EBSCO, and Cochrane Trials. Papers published from January 1, 2013, to December 31, 2017, were subjected to a computerized search. The inclusion criteria were that the randomized controlled trials examined a healthy and community-dwelling older adult population, and the instrument used to evaluate functional fitness was based on “functional fitness” or “senior fitness.” Two reviewers independently assessed the methodological quality of each trial, including study participants, allocation, blinding, data analysis, duration of follow-up and loss to follow-up, intervention, inclusion criteria, outcome measurements, and other biases. Results: Among the 218 trials, only 5 randomized control trials were synthesized in this systematic review. These works examined the effects of the intensity, interval, and duration of intervention programs based on elastic band exercise, aerobic training and combined aerobic and resistance training, Tai Chi with TheraBand resistance exercise, and Tai Chi and Thai Yoga exercise. Conclusions: A 1-hour intervention program, including 10 to 15 minutes of warm-up, 30 to 40 minutes of main exercise, and 5 to 10 minutes of cool-down stages, for 2 to 3 sessions per week, and continuing for 12 to 16 weeks, was the effect intervention for community-dwelling healthy older adults to enhance their upper body strength, lower body flexibility, and agility balance.