BackgroundFrail 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/designThe 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.DiscussionA 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 registrationCurrent Controlled Trials ISRCTN05748494

BackgroundThis study explored the effects of an integrated care model aimed at the frail elderly on the perceived health, objective burden, subjective burden and quality of life of informal caregivers.MethodsA quasi-experimental design with before/after measurement (with questionnaires) and a control group was used. The analysis encompassed within and between groups analyses and regression analyses with baseline measurements, control variables (gender, age, co-residence with care receiver, income, education, having a life partner, employment and the duration of caregiving) and the intervention as independent variables.ResultsThe intervention significantly contributed to the reduction of subjective burden and significantly contributed to the increased likelihood that informal caregivers assumed household tasks. No effects were observed on perceived, health, time investment and quality of life.ConclusionsThis study implies that integrated care models aimed at the frail elderly can benefit informal caregivers and that such interventions can be implemented without demanding additional time investments from informal caregivers. Recommendations for future interventions and research are provided.Trial registrationCurrent Controlled Trials http://ISRCTN05748494. Registration date: 14/03/2013.

ObjectiveThis study explores the processes of integration that are assumed to underlie integrated care delivery.DesignA quasi-experimental design with a control group was used; a new instrument was developed to measure integration from the professional perspective.Setting and participantsProfessionals from primary care practices and home-care organizations delivering care to the frail elderly in the Walcheren region of the Netherlands.InterventionAn integrated care intervention specifically targeting frail elderly patients was implemented.Main Outcome MeasuresStructural, cultural, social and strategic integration and satisfaction with integration.ResultsThe intervention significantly improved structural, cultural and social integration, agreement on goals, interests, power and resources and satisfaction with integration.ConclusionsThis study confirms that integrated care structures foster processes of integration among professionals.Trial registrationCurrent Controlled Trials ISRCTN05748494.

Background:The impact of integrated working on professionals’ objective burden and job satisfaction was examined. An evidence-based intervention targeting frail elderly patients was implemented in the Walcheren region of the Netherlands in 2010. The intervention involved the primary care practice as a single entry point, and included proactive frailty screening, a comprehensive assessment of patient needs, case management, multidisciplinary teams, care plans and protocols, task delegation and task specialisation, a shared information system, a geriatric care network and integrated funding.Methods:A quasi-experimental design with a control group was used. Data regarding objective burden involved the professionals’ time investments over a 12-month period that were collected from patient medical records (n = 377) time registrations, transcripts of meetings and patient questionnaires. Data regarding job satisfaction were collected using questionnaires that were distributed to primary care and home-care professionals (n = 180) after the intervention’s implementation. Within- and between-groups comparisons and regression analyses were performed.Results:Non-patient related time was significantly higher in the experimental group than in the control group, whereas patient-related time did not differ. Job satisfaction remained unaffected by the intervention.Conclusion and Discussion:Integrated working is likely to increase objective burden as it requires professionals to perform additional activities that are largely unrelated to actual patient care. Implications for research and practice are discussed. [Current Controlled Trials ISRCTN05748494].

While integration has become a central tenet of community‐based care for frail elderly people, little is known about its impact on formal and informal care and their dynamics over time. The aim of this study was therefore to examine how an integrated care intervention for community‐dwelling frail elderly people affects the amount and type of formal and informal care over 12 months as compared to usual care. A quasi‐experimental design with a control group was used. Data regarding formal and informal care were collected from frail elderly patients (n = 207) and informal caregivers (n = 74) with pre/post‐questionnaires. Within‐ and between‐group comparisons and multiple linear regression analyses were performed. The results showed marginal changes over time in the amount of formal and informal care in both integrated care and usual care. However, different associations between changes in formal and informal care were found in integrated and usual care. Most notably, informal caregivers provided more instrumental assistance over time if formal caregivers provided less personal care (and vice versa) in integrated care but not in usual care. These results suggest that integrated care does not necessarily change the contribution of formal or informal care, but changes the interaction between formal (personal care) and informal (instrumental) activities. Implications and recommendations for research and practice are discussed. Trial registration: Current Controlled Trials ISRNT05748494.

BackgroundThis study explored the effects of an integrated care model for the frail elderly on informal caregivers’ satisfaction with care and support services.MethodsA 62-item instrument was developed and deployed in an evaluative before/after study using a quasi-experimental design and enrolling a control group. The definitive study population (n = 63) consisted mainly of female informal caregivers who did not live with the care recipient. Analysis of separate items involved group comparisons, using paired and unpaired tests, and regression analyses, with baseline measurements, control variables (sex, age and living together with care recipient) and the intervention as independent variables. Subsequently, the underlying factor structure of the theoretical dimensions was investigated using primary component analysis. Group comparisons and regression analyses were performed on the resulting scales.ResultsSatisfaction with the degree to which care was provided according to the need for care of the recipients increased, while satisfaction with the degree to which professionals provided help with administrative tasks, the understandability of the information provided and the degree to which informal caregivers knew which professionals to call, decreased. Primary component analysis yielded 6 scales for satisfaction with care and 5 scales for satisfaction with caregiver support, with sufficient reliability.ConclusionsThe results suggest that expectations regarding the effects of integrated care on informal caregiver satisfaction may not be realistic. However, the results must be seen in light of the small sample size and should therefore be considered as preliminary. Nonetheless, this study provides guidance for further research and integrated care interventions involving informal caregivers.Trial registrationCurrent Controlled Trials ISRCTN05748494. Date of registration: 14/03/2013.

Background and aim: Traditional care is increasingly being replaced by integrated care models, which often implies changes for health professionals involved. However, although literature on integrated care is abundant, the primary focus is rarely on professionals. Consequently, it is not clear if and how they are affected by integrated care interventions. The aim of this study, therefore, is to provide a systematic review of the literature on the effect of integrated care on professionals.

Introduction:In order to face the challenges associated with an aging population, traditional health care models are increasingly being replaced with integrated care models [1]. However, while evidence exists that these models benefit older people, there is a lack of knowledge about how integrated care affects the informal caregiver [2]. In this study, effects of a new integrated model on the caregivers of frail elderly have been investigated. The model is characterized by an umbrella organizational structure involving case management, multidisciplinary teams, protocols, consultations, and patient files. The aim of this study was to investigate the effects of this model on caregivers in terms of perceived health, quality of life, objective and subjective burden. Theory and Methods:A quasi-experimental design with before/after study and control group was used. Data was gathered using questionnaires (instruments: 2 items of the RAND-36 [3], short form objective burden informal care [4], SRB [5], CarerQoL [6] ,Cantril's Ladder [7]). Analysis encompassed group comparison using paired and unpaired tests and regression analyses with baseline measurements, control variables (sex, age, relation to care-receiver, living together with care-receiver, income, education, having a life partner, employment, durance of care giving) and the intervention as independent variables. Additionally, analyses of subgroups and interaction effects will be performed.Preliminary results: Within and between group differences were found and indicated significant reductions in health (P<0.1) and life ratings (P<0.1) and more financial problems (P<0.05) for the control group. Regression analysis revealed that caregivers in the intervention group were more likely to take on HDL type tasks (P<0.05) and experienced less financial problems (P<0.05). Conclusion:The integrated care intervention increased the likelihood of caregivers performing HDL tasks and reduced their financial problems.