Frail Elderly Syndrome, Frailty, Frailty Syndrome
Conditions
Keywords
frailty care, comprehensive geriatric assessment, care coordination, multidisciplinary team care
Brief summary
Background: Frailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying degrees of effectiveness. However, many of the implementation insights of these care models are contextual, and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care programme in Singapore, that includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multidisciplinary team. The aim of this study is to gain insights on the factors influencing the implementation approaches adopted by five participating sites, and the effectiveness of the programme. Methods: We will adopt a mixed-methods approach that includes a qualitative evaluation among key stakeholders and participants taking part in the programme, through in depth-interviews and focus group discussions. The main topics covered includes factors that affected the development and implementation of each programme, operations and other contextual factors that influenced implementation outcomes. The quantitative evaluation (1) monitors each programme's care process through quality indicators, (2) a multiple-time point survey study to compare programme participants' pre- and post- outcomes on patient engagement (collaboRATE and 13-item Patient Activation Measure;PAM), healthcare experiences (Consumer Assessment of Healthcare Providers and System Clinician and Group Survey Version 3.0; CG-CAHPS), health status and quality of life (Barthel Index of Activities of Daily Living, fall counts, the EuroQol questionnaire and the Control, Autonomy, Self-realization and Pleasure scale; CASP-19), impact on caregivers (Zarit Burden Interview) and societal costs (Client Service Receipt Inventory). (3) A retrospective cohort design to assess healthcare and cost utilisation between participants of the programme and a propensity score matched comparator group. Discussion: The GSH sites share a common goal to increasing accessibility of essential services to frail older adults, and providing comprehensive care. The results of this evaluation study will provide valuable evidence to the impact and effectiveness of the GSH, and inform to the design of similar programmes targeting frail older adults.
Interventions
OTHERThere is no active intervention as this is a service evaluation
There is no active intervention as this is a service evaluation
Sponsors
Alexandra Hospital
Changi General Hospital
Ng Teng Fong General Hospital
Sengkang General Hospital
Singapore General Hospital
Geriatric Education and Research Institute
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
21 Years to 99 Years
Healthy volunteers
Yes
Inclusion criteria
1. Qualitative In depth Interviews/ Policy owners & administrators Inclusion Criteria: * Decision-makers who are higher-level administrators or clinicians who have the authority to make policy and implementation decisions and/ or * Individuals who are familiar with the hospital's overall frailty strategy; and/ or * Individuals that who led the development and implementation of the programme
Exclusion criteria
* Do not meet inclusion criteria above 2. Qualitative Focus group discussions/ Implementation team Inclusion Criteria: * Individuals with time funded through the programme who have been providing services in the GSH for at least six month
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Functional status | April 2019 - September 2022 | It is hypothesised that better functional status, might reduce the healthcare utilisation (emergency hospitalisation, nursing home admission), caregiver burden and the associated indirect cost. In turn, we might expect overall costs to be lower compared to the comparison group. Changes in functional status will be measured using the Barthel Index of Activities of Daily Living (ADL) and Count of falls questionnaire. |
| Health outcomes | April 2019 - September 2022 | It is hypothesised that better health outcomes, might reduce the healthcare utilisation (emergency hospitalisation, nursing home admission), caregiver burden and the associated indirect cost. In turn, we might expect overall costs to be lower compared to the comparison group. Health outcomes will be measured using Quality of Life Questionnaire (EuroQol-5D-5L) and 19-item Quality of Life Scale (CASP-19). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Utilisation of appropriate services | April 2019 - September 2022 | GSH sites offer a range of medical, social and other services through either direct provision or referrals. Given that the model is intended to bridge service gaps (conduct of Comprehensive Geriatric Assessment/ CGA in the community), in the short-term, we hypothesis an increase in the utilisation of appropriate services (rehabilitation, ambulatory services) in this time-limited programme. Utilisation of services will be measured using Client Service Receipt Inventory (CSRI). |
| Patient Satisfaction | April 2019 - September 2022 | GSH participants are expected to benefit from the comprehensive package of health and social services and multidisciplinary team approach. With better care coordination and improved access, it is likely to elicit a higher level of satisfaction relative to comparator groups. Patient satisfaction will be measured using the Consumer Assessment of Healthcare Providers and System Clinician & Group Survey Version 3.0 (CG-CAHPS) tool. |
| Shared decision making/ engagement | April 2019 - September 2022 | Education of the client about self-care, and making decisions about potential care options with inputs from a multidisciplinary team, is expected to result in higher level of shared decision making and engagement relative to comparator groups. Shared decision making/ engagement will be measured using the collaboRATE For Patient - 5-point anchor scale, and 13-item Patient Activation Measure (PAM-13). |
Countries
Singapore
Outcome results
None listed