Fragility, Multimorbidity
Conditions
Keywords
Integrated Health Care Systems, Multimorbid, Multi-domain intervention, Clinical Trials, Randomized
Brief summary
This project aims to examine the effectiveness of the community-based integrated care service model , based on a multi-domain intervention program, among community-dwelling older adults. Moreover, the investigators use the value-based healthcare standard set as well as comprehensive geriatric assessment as outcome measures and to use the randomized controlled trial design to validate the clinical effectiveness.
Detailed description
Population aging and the progress of medical technology are two main causes for the increase of healthcare expenditure. Effective management of medical expenditure and maintenance of health care quality have become the most important task for the public health and clinical care services. Both United Kingdom and the World Health Organization proposed introducing interdisciplinary team care to improve health of older people and to maximize their independence. Prof Michael Porter has addressed the current difficulty of healthcare system, and proposed that healthcare system should pursuit long-term outcome to promote the value of health care. This project aims to echo the international trends, using Taiwan healthcare system as the basis to establish the community-based integrated care service model, and to use the randomized controlled trial design to validate the clinical effectiveness.
Interventions
BEHAVIORALMulti-domain intervention
60 minutes cognitive training, 45 minutes physical exercise, 15 diet nutrition and intermittent disease management consultation
Sponsors
National Yang Ming Chiao Tung University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age ≧ 65 years * three or more chronic conditions, defined by National Health Insurance list of chronic conditions * covered by National Health Insurance
Exclusion criteria
* could not understanding protocol or communication with research nurses * malignant diseases under active treatments * life expectancy less than twelve months * admitted in the long term facility
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes from baseline life quality at 3, 6, 9, 12 month | baseline, 3, 6, 9, 12 month | measured by the 36-Item Short Form Health Survey (SF-36). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes from baseline standard set of health outcome measures for older persons at 3, 6, 9, 12 month | baseline, 3, 6, 9, 12 month | a standard health care set proposed by the International Consortium for Health Outcomes Measurement (ICHOM) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Changes from baseline total cholesterol in mg/dl at sixth and twelfth month | baseline, 6,12 month | Changes from baseline total cholesterol in mg/dl at sixth and twelfth month |
| Changes from baseline triglycerides in mg/dl at sixth and twelfth month | baseline, 6,12 month | Changes from baseline triglycerides in mg/dl at sixth and twelfth month |
| Changes from baseline HDL-C in mg/dl at sixth and twelfth month | baseline, 6,12 month | Changes from baseline High-density lipoproteins (HDL) in mg/dl at sixth and twelfth month |
| Changes from baseline LDL-C in mg/dl at sixth and twelfth month | baseline, 6,12 month | Changes from baseline Low-density lipoproteins (LDL) in mg/dl at sixth and twelfth month |
| Changes from baseline fasting glucose in mg/dl at sixth and twelfth month | baseline, 6,12 month | Changes from baseline fasting glucose in mg/dl at sixth and twelfth month |
| Changes from baseline HbA1c in % at sixth and twelfth month | baseline, 6,12 month | Changes from baseline Hemoglobin A1c in % at sixth and twelfth month |
| Changes from baseline insulin in mIU/L at sixth and twelfth month | baseline, 6,12 month | Changes from baseline insulin in mIU/L at sixth and twelfth month |
| Changes from baseline uric acid in mg/dl at sixth and twelfth month | baseline, 6,12 month | Changes from baseline uric acid in mg/dl at sixth and twelfth month |
| Changes from baseline body mass index in kg/m^2 at sixth and twelfth month | baseline, 6,12 month | Changes from baseline body mass index in kg/m\^2 at sixth and twelfth month |
| Changes from baseline albumin in g/dl at sixth and twelfth month | baseline, 6,12 month | Changes from baseline albumin in g/dl at sixth and twelfth month |
| Changes from baseline Vitamin D in ng/ml at sixth and twelfth month | baseline, 6,12 month | Changes from baseline Vitamin D in ng/ml at sixth and twelfth month |
| Changes from baseline Vitamin B12 in pg/ml at sixth and twelfth month | baseline, 6,12 month | Changes from baseline Vitamin B12 in pg/ml at sixth and twelfth month |
| Changes from baseline homocysteine in micromol/l at sixth and twelfth month | baseline, 6,12 month | Changes from baseline homocysteine in micromol/l at sixth and twelfth month |
| Changes from baseline high sensitive C-Reactive Protein in mg/dl at sixth and twelfth month | baseline, 6,12 month | Changes from baseline high sensitive C-Reactive Protein in mg/dl at sixth and twelfth month |
Countries
Taiwan
Outcome results
None listed