Objective To assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care.Design Cluster randomised controlled trial with one year follow-up.Setting 41 low level dependency residential care homes in New Zealand.Participants 682 people aged 65 years or over.Interventions 330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants; 352 residents received social visits.Main outcome measures Function (late life function and disability instruments, elderly mobility scale, FICSIT-4 balance test, timed up and go test), quality of life (life satisfaction index, EuroQol), and falls (time to fall over 12 months). Secondary outcomes were depressive symptoms and hospital admissions.

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growth predicted in the residential aged care sector is not yet evident. The introduction of standardised needs assessments before entry, increased availability of home-based services, and growth in retirement villages may have led to reduced utilisation.

The authors aimed to use existing data to create a microsimulation model of the primary care process in New Zealand, including realistically simulating the allocation of general practitioners (GPs) to a population sample. This is important because GP behavior is likely to be a major determinant of future cost and service outcomes. Two nationally representative data sets were matched: a sample of GPs and their patients from the National Primary Medical Care Survey (NPMCS) and a population sample from the New Zealand Health Survey (NZHS). Matching involved first dividing the data sets into cells based on common variables. Further variables were then included in a distance function to guide matching within cells. A transportation optimization algorithm allocated GPs based on these-on similarities in patients' attributes. Statistical matching performed well with high correlations for patient attributes and reduced average absolute rank differences on proportions of patients among GPs compared to random matching. Low KullbackLeibler (K-L) divergences confirmed that our method of statistical matching had allocated GPs realistically. Models of primary care too frequently omit the role of the practitioner in driving health service outcomes. The authors developed a method to impute characteristics of GPs to a population-based microsimulation model of primary care.

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