Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition)

Abstract

BackgroundCare for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling frail older adults.Methods/designIn a 2-year stepped-wedge cluster randomised clinical trial with 6-monthly measurements, the chronic care model will be compared with usual care. The trial will be carried out among 35 primary care practices in two regions in the Netherlands. Per region, practices will be randomly allocated to four allocation arms designating the starting point of the intervention. Participants: 1200 community-dwelling older adults aged 65 or over and their primary informal caregivers. Primary care physicians will identify frail individuals based on a composite definition of frailty and a polypharmacy criterion. Final inclusion criterion: scoring 3 or more on a disability case-finding tool. Intervention: Every 6 months patients will receive a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Expert teams will manage and train practice nurses. Patients with complex care needs will be reviewed in interdisciplinary consultations. Evaluation: We will perform an effect evaluation, an economic evaluation, and a process evaluation. Primary outcome is quality of life as measured with the Short Form-12 questionnaire. Effect analyses will be based on the “intention-to-treat” principle, using multilevel regression analysis. Cost measurements will be administered continually during the study period. A cost-effectiveness analysis and cost-utility analysis will be conducted comparing mean total costs to functional status, care needs and QALYs. We will investigate the level of implementation, barriers and facilitators to successful implementation and the extent to which the intervention manages to achieve the transition necessary to overcome challenges in elderly care.DiscussionThis is one of the first studies assessing the effectiveness, cost-effectiveness and implementation process of the chronic care model for frail community-dwelling older adults.Trial registrationThe Netherlands National Trial Register NTR2160.

How effective is integrated care for community-dwelling frail older people? The case of the Netherlands

“…All studies recruited their participants from primary care settings. In the ACT trial, the PRISMA-7 questionnaire was used to assess frailty by telephone [5,6]. In the PoC trial, a postal questionnaire was used to identify frail older people: the Groningen Frailty Indicator [7].…”

Comparing Measurement Properties of the EQ-5D-3L, ICECAP-O, and ASCOT in Frail Older Adults

“…The study population consisted of a sample of participants of the "frail older Adults: Care in Transition" (ACT) study in The Netherlands [32]. This stepped wedge cluster randomized controlled trial was designed to evaluate a geriatric care model based on the chronic care model [33] for frail older adults living at home.…”

“…This stepped wedge cluster randomized controlled trial was designed to evaluate a geriatric care model based on the chronic care model [33] for frail older adults living at home. The ACT study is described in more detail elsewhere [32]. Eligible participants were identified in 35 general practices in two regions of The Netherlands, using the seven-question "program on research for integrating services for the maintenance of autonomy" tool, a brief seven-item questionnaire containing risk factors for functional decline [34][35][36].…”

The Importance of Trust in Successful Home Visit Programs for Older People

“…Based on the Chronic Care Model (Bodenheimer, Wagner, & Grumbach, 2002), the GCM aims to improve quality of care and, subsequently, frail older people’s quality of life by enabling productive interactions between activated, informed older people and proactive, prepared care professionals (Muntinga et al, 2012). A central component of the GCM is a proactive home visit program carried out by practice nurses.…”