Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Ruikes, Franca G H; Zuidema, Sytse U.; Akkermans, Reinier; Assendelft, W.J.J.; Schers, Henk; Koopmans, Raymond T.C.M.

doi:10.3122/jabfm.2016.02.150214

Cited by 55 publications

(85 citation statements)

References 38 publications

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“…However, some of the intervention components and context factors might be similar in other cases and given the detailed explanations of the setting provided here, we believe our results to hold much learning potential for other organisations currently implementing or planning to implement integrated care interventions for geriatric and other chronic conditions. This is especially relevant given the fact that many studies on integrated geriatric care stem from the Dutch context and insights from other settings are still relatively sparse [21–23]. …”

Section: Discussionmentioning

confidence: 99%

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Busetto

Kiselev

Steinhagen‐Thiessen

et al. 2017

BMC Health Serv Res

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BackgroundMany health systems have implemented integrated care as an alternative approach to health care delivery that is more appropriate for patients with complex, long-term needs. The objective of this article was to analyse the implementation of integrated care at a German geriatric hospital and explore whether the use of a “context-mechanisms-outcomes”-based model provides insights into when and why beneficial outcomes can be achieved.MethodsWe conducted 15 semi-structured interviews with health professionals employed at the hospital. The data were qualitatively analysed using a “context-mechanisms-outcomes”-based model. Specifically, mechanisms were defined as the different components of the integrated care intervention and categorised according to Wagner’s Chronic Care Model (CCM). Context was understood as the setting in which the mechanisms are brought into practice and described by the barriers and facilitators encountered in the implementation process. These were categorised according to the six levels of Grol and Wensing’s Implementation Model (IM): innovation, individual professional, patient, social context, organisational context and economic and political context. Outcomes were defined as the effects triggered by mechanisms and context, and categorised according to the six dimensions of quality of care as defined by the World Health Organization, namely effectiveness, efficiency, accessibility, patient-centeredness, equity and safety.ResultsThe integrated care intervention consisted of three main components: a specific reimbursement system (“early complex geriatric rehabilitation”), multidisciplinary cooperation, and comprehensive geriatric assessments. The inflexibility of the reimbursement system regarding the obligatory number of treatment sessions contributed to over-, under- and misuse of services. Multidisciplinary cooperation was impeded by a high workload, which contributed to waste in workflows. The comprehensive geriatric assessments were complemented with information provided by family members, which contributed to decreased likelihood of adverse events.ConclusionsWe recommend an increased focus on trying to understand how intervention components interact with context factors and, combined, lead to positive and/or negative outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2105-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Busetto

Kiselev

Steinhagen‐Thiessen

et al. 2017

BMC Health Serv Res

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“…Information provided about the exact content of the instrument varied between CGAs. For five CGA instruments, the content of the CGA was available in (the appendix of) the original study or in a study cited in the original study (Buurman et al, ; Buurman, Parlevliet, van Deelen, de Haan, & de Rooij, ; Fleischer et al, ; Ruikes et al, , ; Stijnen, Duimel‐Peeters, et al, ; Suijker et al, , ). For the other CGAs, the original study did not provide or only partially provided the exact content of the CGA nor referred to other papers describing this information.…”

Section: Resultsmentioning

confidence: 99%

“…Three CGA instruments were tested for their validity and reliability (De Stampa et al, ; Ruikes et al, , ; Van Hout et al, ; Vedel et al, ). For four CGAs, it was explicitly indicated that the instrument was tested for its feasibility (Daniels et al, ; Metzelthin, van Rossum, de Witte, Hendriks, & Kempen, ; Metzelthin et al, ; Ruikes et al, , ; Stijnen, Duimel‐Peeters, et al, ; Suijker et al, , ). For nine CGAs, the average duration of conducting the assessment was described, which ranged from 30 min to 3 hr.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, domains were defined in different ways in CGAs. For example, in some CGAs, cognitive functioning was part of the psychological/mental domain (Kono et al, ; Stijnen, Duimel‐Peeters, et al, ; Suijker et al, , ), while in other CGAs, cognition was a domain separate from the psychological/mental domain (Boult et al, ; Boyd et al, ; Ruikes et al, , ).…”

Section: Resultsmentioning

confidence: 99%

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Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Stoop

Lette

Gils

et al. 2019

Health Soc Care Community

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In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person‐centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006–2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty‐seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty‐one different CGAs were identified, of which the EASYcare instrument, RAI‐HC/RAI‐CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person‐centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter‐)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.

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“…The second, from the Netherlands, found that a specific team-based intervention for frail elderly in their homes did not lead to improvements in overall function or mortality. 5 For our thought piece this month, Howard et al 6 note that many practices undergoing transformation are using different terminology than are associated nationally with the PCMH initiative. These differences suggest future directions or areas that are inadequately addressed through the classic PCMH model.…”

mentioning

confidence: 99%

Outcomes of Health System Structures, Highly Pertinent Clinical Information, Idea Stimulators, Clinical Reviews, and Prediction Tools: JABFM Exemplified

Bowman¹,

Neale²,

Seehusen³

2016

The Journal of the American Board of Family Medicine

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This issue exemplifies the types of articles that JABFM publishes to advance family medicine. We have articles on the implications of health system organizational structures. Three of these are international articles at the level of the national health system (1 from China) and systematic local health interventions (1 from Canada and 1 from Netherlands). Inside the United States, where there are more family physicians, there is less obesity, and designation as a Patient Centered Medical Home is related to increased rates of colorectal cancer screening. Review articles on common clinical topics discuss treatments that are changing (acne in pregnancy) or lack consensus (distal radial fractures). We have articles on making life easier in the office, such as for predicting Vitamin D levels, osteoporosis, and prediabetes in normal weight adults. There are articles to raise awareness of the "newest" testing or treatments, that is, auditory brainstem implants. "Reminder" articles highlight known entities that need to be reinforced to prevent over-/underdiagnosis or treatment, for example, "cotton fever." Another article discusses the increased risk for postoperative complications with sleep apnea. We also provide "thought" pieces, in this case about the terminology we are using to extend our concept of patient-cen- Systems of care make a difference. In the United States, areas with more family physicians per population have lower rates of obesity after controlling for other factors.1 Patient-centered medical homes (PCMHs) are associated with increased rates of colorectal cancer screening compared with another targeted intervention.2 Articles from international sources also help us to understand how the structures of health systems contribute to health and illness. We highlight an article herein on a lack of primary care clinicians in the Chinese health care system 3 and 2 articles on health care-based systems of care for the frail elderly. The first, from Canada, 4 found that instituting a specific care system in long-term care facilities reduced trips to the emergency department by one third. The second, from the Netherlands, found that a specific team-based intervention for frail elderly in their homes did not lead to improvements in overall function or mortality. 5For our thought piece this month, Howard et al 6 note that many practices undergoing transformation are using different terminology than are associated nationally with the PCMH initiative. These differences suggest future directions or areas that are inadequately addressed through the classic PCMH model.Highly pertinent clinical articles reflect on common clinical problems and lack of evidence or disagreements about best treatments. For distal radius closed fractures, there is clearly insufficient evidence on the "best" treatment. These fractures, without complicating features, can be handled without surgery, 7 thus permitting treatment in the family medicine setting. We have a clinical review article about treating acne during pregnancy. 8 Whether or not ...

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Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Cited by 55 publications

References 38 publications

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Outcomes of Health System Structures, Highly Pertinent Clinical Information, Idea Stimulators, Clinical Reviews, and Prediction Tools: JABFM Exemplified

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