Local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro): study protocol of a randomised comparative effectiveness trial

Abstract

Background Multimorbid older adults suffering from a long-term health condition like depression, diabetes mellitus type 2, dementia or frailty are at high risk of losing their autonomy. Disability and multimorbidity in the older population are associated with social inequality and lead to soaring costs. Our local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro-Care) aims at improving outcomes for older multimorbid patients with chronic conditions whose social and medical care must be improved. Methods The study will evaluate the effects of LoChro-Care on functional health, depressive symptoms and satisfaction with care, resource utilisation as well as health costs in older persons with long-term conditions. The trial will compare the effectiveness of LoChro-Care and usual care in a cross-sectoral setting from hospital to community care. We will recruit 606 older adults (65+) admitted to local hospital inpatient or outpatient departments who are at risk of loss of independence. Half of them will be randomised to receive the LoChro-Care intervention, comprising seven to 16 contacts with chronic care managers (CCM) within 12 months. The hypothesis that LoChro-Care will result in better patient-centred outcomes will be tested through mixed-method process and outcome evaluation and valid measures completed at baseline and at 12 and 18 months. Cost-effectiveness analyses from the healthcare perspective will include incremental cost-effectiveness ratios. Discussion The trial will provide evidence about the effectiveness of local, collaborative, stepped and personalised care management for multimorbid patients with more than one functional impairment or chronic condition. Positive results will be a first step towards the implementation of a systematic cross-sectoral chronic care management to facilitate the appropriate use of available medical and nursing services and to enhance self-management of older people. Trial registration German Clinical Trials Register (DRKS): DRKS00013904 ; Trial registration date: 02. February 2018.

Specific content for collaborative care: a systematic review of collaborative care interventions for patients with multimorbidity involving depression and/or anxiety in primary care

“…In the excluded full-text studies ( Supplementary data ) 2 of 33 37 , 38 included multimorbid patients with at least 2 chronic diseases. These were excluded as depression and/or anxiety were not inclusion criterion, and primary outcome was health improvement.…”

Analysis of the key themes in the healthcare of older people with multimorbidity in Germany: a framework analysis as part of the LoChro trial

“…The ISAR, a six-item score, has been shown to be associated with unplanned readmissions, institutionalisation and the need for nursing care in older patients in Germany 42. Exclusion criteria for the LoChro trial were as follows:1 terminal medical conditions,2 lack of basic German-language skills or no German-speaking caregiver available and3 not residing in the region 39…”

Factors limiting the motor rehabilitation of elderly disabled persons with lower limb loss

“…Так, в 2017 г. глобальная продолжительность жизни составила 73 года, в то время как продолжительность здоровой жизни -лишь 63,3 года [1]. При этом среди людей пожилого возраста широко распространена мультиморбидность [2], которая, как предполагают в связи с ожидаемым увеличением стареющего населения, станет ещё более распространённой в будущем [3].…”