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BMC Geriatrics
Published in: BMC Geriatrics 1/2013

Open Access 01-12-2013 | Study protocol

Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs

Authors: Isabelle Natalina Fabbricotti, Benjamin Janse, Wilhelmina Mijntje Looman, Ruben de Kuijper, Jeroen David Hendrikus van Wijngaarden, Auktje Reiffers

Published in: BMC Geriatrics | Issue 1/2013

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Abstract

Background

Frail elderly persons living at home are at risk for mental, psychological, and physical deterioration. These problems often remain undetected. If care is given, it lacks the quality and continuity required for their multiple and changing problems. The aim of this project is to improve the quality and efficacy of care given to frail elderly living independently by implementing and evaluating a preventive integrated care model for the frail elderly.

Methods/design

The design is quasi-experimental. Effects will be measured by conducting a before and after study with control group. The experimental group will consist of 220 elderly of 8 GPs (General Practitioners) who will provide care according to the integrated model (The Walcheren Integrated Care Model). The control group will consist of 220 elderly of 6 GPs who will give care as usual. The study will include an evaluation of process and outcome measures for the frail elderly, their caregivers and health professionals as well as a cost-effectiveness analysis. A concurrent mixed methods design will be used. The study population will consist of elderly 75 years or older who live independently and score a 4 or higher on the Groningen Frailty Indicator, their caregivers and health professionals. Data will be collected prospectively at three points in time: T0, T1 (3 months after inclusion), and T2 (12 months after inclusion). Similarities between the two groups and changes over time will be assessed with t-tests and chi-square tests. For each measure regression analyses will be performed with the T2-score as the dependent variable and the T0-score, the research group and demographic variables as independent variables.

Discussion

A potential obstacle for this study will be the willingness of the elderly and their caregivers to participate. To increase willingness, the request to participate will be sent via the elders’ own GP. Interviewers will be from their local region and gifts will be given. A successful implementation of the integrated model is also necessary. The involved parties are members of a steering group and have contractually committed themselves to the project.

Trial registration

Current Controlled Trials ISRCTN05748494
Appendix
Available only for authorised users
Literature
1.
Slaets JPJ: Vulnerability in the Elderly: Frailty. Medical Clinics of North America. 2006, 90 (4): 593-601. 10.1016/j.mcna.2006.05.008.CrossRefPubMed
2.
The Netherlands Institute for Social Research (SCP): Frail older persons in the Netherlands. 2011, The Hague: SCP
3.
Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM: Towards an integral conceptual model of frailty. J Nutr Health Aging. 2010, 14 (3): 175-181. 10.1007/s12603-010-0045-6.CrossRefPubMed
4.
Fried LP, Tangen C, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001, 56 (3): M146-M156. 10.1093/gerona/56.3.M146.CrossRefPubMed
5.
Zantinge E, van der Wilk E, Schoenmaker C, van Wieren M: De gezondheid van ouderen in Nederland. 2011, Bilthoven: National Institute for Public Health and the Environment (RIVM)
6.
Van Campen C, Ras M, Van D: Introduction and Estimate of the number of frail older persons up to the year 2030. Frail older persons in the Netherlands. Edited by: van Campen C. 2011, The Hague: SCP, 19-23. 71
7.
Iecovich E: Caregiving Burden, Community Services, and Quality of Life of Primary Caregivers of Frail Elderly Persons. J Appl Gerontol. 2008, 27 (3): 309-330. 10.1177/0733464808315289.CrossRef
8.
Donelan K, Hill CA, Hoffman C, Scoles K, Feldman PH, Levine C, Gould D: Challenged to care: Informal caregivers in a changing health system. Health Aff. 2002, 21 (4): 223-231.CrossRef
9.
Van Eijken M: Strategies for improving community health care for the elderly. 2007, Nijmegen: Radboud University
10.
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care. J Gerontol. 2004, 59 (3): 255-263. 10.1093/gerona/59.3.M255.CrossRef
11.
Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, Monaghan N, Aggar C, Gill L, Cameron ID: Treating frailty-a practical guide. BMC Med. 2011, 6 (9): 83-CrossRef
12.
Espinoza S, Walston JD: Frailty in older adults: insights and interventions. Cleve Clin J Med. 2005, 72 (12): 1105-1112. 10.3949/ccjm.72.12.1105.CrossRefPubMed
13.
Challis D, Chessum R, Chesterman J, Luckett R, Woods B: Community Care for the Frail Elderly: An Urban Experiment. Br J Soc Work. 1987, 18 (supp): 13-42.
14.
De Klerk MMY: Care and housing for vulnerable elderly. 2004, The Hague: SCP
15.
Daniels R, van Rossum E, de Witte L, Kempen GI, van den Heuvel W: Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res. 2008, 30 (8): 278-CrossRef
16.
Landi F, Onder G, Carpenter I, Cesari M, Soldato M, Bernabei R: Physical activity prevented functional decline among frail community-living elderly subjects in an international observational study. J Clin Epidemiol. 2007, 60 (5): 518-524. 10.1016/j.jclinepi.2006.09.010.CrossRefPubMed
17.
Bleijenberg N, Drubbel I, Ten Dam VH, Numans ME, Schuurmans MJ, de Wit NJ: Proactive and integrated primary care for frail older people: design and methodological challenges of the Utrecht primary care PROactive frailty intervention trial (U-PROFIT). BMC Geriatr. 2012, 25: 12-16.
18.
Haug M: Elderly patients, caregivers and physicians: Theory and research on health care triads. J Health Soc Behav. 1994, 35 (1): 1-12. 10.2307/2137331.CrossRefPubMed
19.
Ekdahl AW, Andersson L, Friedrichsen M: "They do what they think is the best for me." Frail elderly patients' preferences for participation in their care during hospitalization. Patient Educ Couns. 2010, 80: 233-240. 10.1016/j.pec.2009.10.026.CrossRefPubMed
20.
Leichsenring K: Developing integrated health and social care services for older persons in Europe. International Journal of Integrated Care. 2004, 4: 1-CrossRef
21.
Bergman HF, Beland F, Lebel P, Contandriopoulos AP, Tousignant P, Brunelle Y, Kaufman T, Leibovich E, Rodriguez R, Clarfield M: Care for Canada's frail elderly population: Fragmentation or integration?. CMAJ. 1997, 157 (8): 1116-1121.PubMedPubMedCentral
22.
Gröne O, Garcia-Barbero M: Integrated care: a positioning paper of the WHO European office for integrated health care services. International Journal of Integrated Care. 2001, 1: 1-CrossRef
23.
Ganz DA, Fung CH, Sinsky CA, Wu S, Reuben DB: Key Elements of High-Quality Primary Care for Vulnerable Elders. J Gen Intern Med. 2008, 23 (12): 2018-23. 10.1007/s11606-008-0808-5.CrossRefPubMedPubMedCentral
24.
Hébert R, Durand PJ, Dubuc N, Tourigny A: Prisma: a new model of integrated service delivery for the frail older people in Canada. International Journal of Integrated Care. 2003, 3: 1-CrossRef
25.
Kodner DL: Fully integrated care for frail elderly: two American models. International Journal of Integrated Care. 2000, 1: 1-CrossRef
26.
Reed J, Cook G, Childs S, McCormack B: A literature review to explore care for older people. International Journal of Integrated care. 2005, 5: 1-CrossRef
27.
Glendinning C: Braking down barriers: integrating health and care services for older people in England. Health Policy. 2002, 65 (2): 139-151.CrossRef
28.
Hardy B, Mur-Veeman I, Steenbergen M, Wistow G: Inter-agency services in England and The Netherlands; a comparative study of integrated care development and delivery. Health Policy. 1999, 48 (2): 87-105. 10.1016/S0168-8510(99)00037-8.CrossRefPubMed
29.
Fabbricotti IN: Taking care of integrated care: integration and fragmentation in the development of integrated care arrangements. PhD thesis. 2007, Erasmus University Rotterdam, institute of health policy and management
30.
Bernabei R, Lani F, Gambassi G, Sgadari A, Zuccala G, Mor V, Rubenstein LZ, Carbonin P: Randomised trial of impact of integrated care and case management for older people living in community. BMJ. 1998, 316 (May): 1348-1351.CrossRefPubMedPubMedCentral
31.
Elkan R, Kendrick D, Dewey M, Hewitt M, Robinson J, Blair M, Williams D, Brummel K: Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ. 2001, 323 (7315): 719-725. 10.1136/bmj.323.7315.719.CrossRefPubMedPubMedCentral
32.
Johri M, Beland F, Bergman H: International experiments in integrated care for the elderly: a synthesis of evidence. Int J Geriatr Psychiatry. 2003, 18 (3): 222-235. 10.1002/gps.819.CrossRefPubMed
33.
Kodner DL: Integrated Care Networks for vulnerable elderly: North American prototypes, performance and lessons. International Journal of Integrated Care. 2008, 8: 1-CrossRef
34.
Van Hout HPJ, Jansen APD, van Marwijk HWL, Pronk M, Frijters D, Nijpels G: Prevention of Adverse Health Trajectories in a Vulnerable Elderly Population Through Nurse Home Visits: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci. 2010, 65 (7): 734-742.CrossRefPubMed
35.
Tourigny A: Quasi-experimental study of the effectiveness of an integrated service delivery network for the frail elderly. Can J Aging. 2004, 23 (3): 231-246.CrossRefPubMed
36.
Leveille SG, Wagner EH, Davis C, Grothaus L, Wallace J, Logerfo M, Kent D: Preventing disability and managing chronic illness in frail older adults: A randomized trial of a community-based partnership with primary care. J Am Geriatr Soc. 1998, 46 (10): 1191-8.CrossRefPubMed
37.
Eklund K: Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trials. Health Soc Care Community. 2009, 17 (5): 447-58. 10.1111/j.1365-2524.2009.00844.x.CrossRefPubMed
38.
Hebert R, Raiche M, Dubois MF, Gueye NR, Tousignant M: 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. 2010, 65B (1): 107-118. 10.1093/geronb/gbp027.CrossRef
39.
Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JPJ: Old or frail: what tells us more?. Journals of Gerontology. 2004, 59 (9): 962-965. 10.1093/gerona/59.9.M962.CrossRef
40.
Steverink N, Slaets JPJ, Schuurmans H, van Lis M: Measuring frailty: development and testing of the Groningen Frailty Indicator (GFI). The Gerontologist. 2001, 41 (special issue 1): 236-237.
41.
Melis RJ, van Eijken MI, Teerenstra S, van Achterberg T, Parker SG, Borm GF, van de Lisdonk EH, Wensing M, Rikkert MG: A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home. J Gerontol A Biol Sci Med Sci. 2008, 63 (3): 283-90. 10.1093/gerona/63.3.283.CrossRefPubMed
42.
Ware JE, Sherbourne CD: The RAND-36 Short-form Health Status Survey: 1, Conceptual framework and item selection. Medical Care. 1992, 30 (6): 473-481. 10.1097/00005650-199206000-00002.CrossRefPubMed
43.
Brazier E, Harper R, Jones NMB, O'Cathain A, Thomas KJ, Usherwood T, Westlake L: Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992, 305 (6846): 160-164. 10.1136/bmj.305.6846.160.CrossRefPubMedPubMedCentral
44.
Makai P, Brouwer WB, Koopmanschap MA, Nieboer AP: Capabilities and quality of life in Dutch psycho-geriatric nursing homes: an exploratory study using a proxy version of the ICECAP-O. Qual Life Res. 2012, 21 (5): 801-12. 10.1007/s11136-011-9997-1.CrossRefPubMed
45.
Group EQ: EuroQol-a new facility for the measurement of health-related quality of live. Health Policy. 1990, 16 (3): 199-208.CrossRef
46.
Krabbe PF, Stouthard ME, Essink-Bot ML, Bonsel GJ: The effect of adding a cognitive dimension to the EuroQOl multiattribute health-status classification system. J Clin Epidemol. 1999, 52 (4): 293-301. 10.1016/S0895-4356(98)00163-2.CrossRef
47.
Cantril H: The pattern of human concerns. 1965, New Brunswick, NJ: Rutgers University Press
48.
Weinberger M, Samsa GP, Schmader K, Greenberg SM, Carr DB, Wildman DS: Comparing proxy and patients’ perceptions of patients’ functional status: results from an outpatient geriatric clinic. J Am Geriatr Soc. 1992, 40 (6): 585-8.CrossRefPubMed
49.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged, The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963, 185 (21): 914-919.CrossRefPubMed
50.
de Berg V, Spauwen P: Measurement of informal care: an empirical study into the valid measurement of time spent on informal caregiving. Health Econ. 2006, 15 (5): 447-60. 10.1002/hec.1075.CrossRef
51.
Hoefman RJ, van Exel NJA, Foets MME, Brouwer WBF: Sustained informal care: The feasibility, construct validity and test-retest reliability of the CarerQol-instrument to measure the impact of informal care in long-term care. Aging Ment Health. 2011, 15 (8): 1018-1027. 10.1080/13607863.2011.575351.CrossRefPubMed
52.
Brouwer WB, van Exel NJ, van Gorp B, Redekop WK: The CarerQol instrument: a new instrument to measure care‒related quality of life of informal caregivers for use in economic evaluations. Qual Life Res. 2006, 15 (6): 1005-21. 10.1007/s11136-005-5994-6.CrossRefPubMed
53.
Van Exel NJ, op Reimer WJ S, Brouwer WBF, van de Berg B, Koopmanschap MA, van den Bos GA: Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: A comparison of CSI, CRA, SCQ and self-rated burden. Clin Rehabil. 2004, 18 (2): 203-214. 10.1191/0269215504cr723oa.CrossRefPubMed
54.
Robinson BC: Validation of the caregiver strain index. J Gerontol. 1983, 38 (3): 344-348. 10.1093/geronj/38.3.344.CrossRefPubMed
55.
Al-Janabi H, Frew E, Brouwer W, Rappange D, van Exel J: The inclusion of Positive Aspects of Caring in the Caregiver Strain Index: Tests of Feasibility and Validity. Int J Nurs Stud. 2010, 47 (8): 984-993. 10.1016/j.ijnurstu.2009.12.015.CrossRefPubMed
56.
Kraijo H, Brouwer W, de Leeuw R, Schrijvers G, van Exel J: Coping with Caring: Profiles of Caregiving by Informal Carers Living with a Loved One Who has Dementia. Dementia. 2012, 11 (1): 113-130. 10.1177/1471301211421261.CrossRef
57.
Collins C, Stommel M, King S, Given CW: Assessment of the Attitudes of Family Caregivers Toward Community Services. Gerontologist. 1991, 31 (6): 756-761. 10.1093/geront/31.6.756.CrossRefPubMed
58.
Warr P: The measurement of well-being and other aspects of mental health. J Occup Psychol. 1990, 63 (3): 193-210. 10.1111/j.2044-8325.1990.tb00521.x.CrossRef
59.
Hills D, Joyce C, Humphreys J: Validation of a job satisfaction Scale in the Australian Clinical medical Workforce. Evaluation & the Health Professional. 2011, 35 (1): 47-76.CrossRef
60.
Rutten M: Kostenberekening bij gezondheidszorgonderzoek. 1993, Utrecht: STG
61.
Oostenbrink M: Handleiding voor kostenonderzoek: Geactualiseerde versie 2004. 2004, Rotterdam: iMTA
62.
Gittel JH: Coordinating Mechanisms in Care Provider Groups: Relational Coordination as a Mediator and Input Uncertainty as a Moderator of Performance Effects. Management Science. 2002, 48 (11): 1408-1426. 10.1287/mnsc.48.11.1408.268.CrossRef
63.
Gittel JH: A relational theory of coordination: Coordinating work through relationships of shared goals, shared knowledge and mutual respect. 2002, Unpublished
64.
Delnoij D, Hendriks M: De CQ-index: het meten van klantervaringen in de zorg. TSG. 2008, 86 (8): 440-446. 10.1007/BF03082141.CrossRef
65.
Delnoij D: Klantervaringen in de zorg meten met CQ index. 2006, Utrecht: Nivel
66.
Hardy B, van Raak A, Mur-Veeman I, Steenbergen M, Paulus A: Introduction. Integrated care in Europe; description and comparison of integrated care in six EU countries. Edited by: van Raak A, Mur-Veeman I, Hardy B, Steenbergen M, Paulus A. 2003, Maarssen: Elsevier Gezondheidszorg, 9-14. 1
67.
Kodner DL: Consumer-directed services: lessons and implications for integrated systems of care. International Journal of Integrated Care. 2003, 3: 1-CrossRef
68.
Mur-Veeman I, Eijkelberg I, Spreeuwenberg C: How to manage the implementation of shared care; a discussion of the role of power, culture and structure and the development of shared care arrangements. J Manag Med. 2001, 15 (2): 142-155. 10.1108/02689230110394552.CrossRefPubMed
69.
Berkhout AJMB: Resident-oriented care in nursing homes: an evaluation study of the model of resident oriented care, the implementation and the effects. PhD thesis. 2000, Datawyse Maastricht
70.
Robson C: Real world research: a resource for social scientist and practitioner—research. 2002, Hoboken: John Wiley & Sons
71.
Polt DF, Hungler BP: Nursing research: principles and methods. 1999, Philadelphia: Lippincott Williams
Metadata
Title
Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs
Authors
Isabelle Natalina Fabbricotti
Benjamin Janse
Wilhelmina Mijntje Looman
Ruben de Kuijper
Jeroen David Hendrikus van Wijngaarden
Auktje Reiffers
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2013
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-13-31

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