English: Care model Integrated care Elderly (people) Dutch: Zorgmodel Samenhangende zorg Ouderen
Conditions
Interventions
The Integrated Elderly Care Program is an intervention program in which patients aged 75 years and older who are registered with a general practitioner, and who are assigned to the intervention group,
Sponsors
University Medical Center Groningen
Eligibility
Inclusion criteria
Inclusion criteria: 1. People aged 75 years and older; 2. Living at home or in a retirement home; 3. Registered with one of the 15 participating general practitioners.
Exclusion criteria
Exclusion criteria: 1. Long term stay in a home for the elderly, in a nursing home or in another long-term care facility; 2. Receiving other types of integrated care; 3. Participating in another study.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Elderly: Complexity of care needs (INTERMED), 12 months. Caregivers: Caregiver burden (Caregiver Strain Index (CSI)), 12 months. Quality of care: Complexity of care needs (INTERMED), 12 months. Health care use and costs: Health care plans, Quality Adjusted Life Year (QALY), 12 months. | — |
Secondary
| Measure | Time frame |
|---|---|
| Elderly: 1. Frailty (Groninger Frailty Indicator (GFI)), 12 months; 2. Wellbeing (Welbevindenlijst, RAND 36-item Health Survey (RAND-36) in the Minimal Data Set (MDS)), 12 months; 3. Self management ability (Self-Management Ability Scale (SMAS-30)), 12 months; 4. Self management knowledge (Partners In Health Scale (PIH scale)), 12 months; 5. Quality of life (EQ-5D in the Minimal Data Set (MDS)), 12 months. Caregiver: 1. Caregiver burden (Self-rated Burden Visual Analogue Scale (Self-rated Burden VAS) and the Carer Quality of Life (Carer QOL)), 12 months; 2. Experienced health (RAND-36 in MDS), 12 months; 3. Experienced quality of life (RAND-36 and Cantrill’s Ladder in MDS), 12 months. Quality of care: 1. Goal attainment, 12 months; 2. Patient experiences and satisfaction (Patient Assessment of Chronic Illness Care (PACIC)), 12 months. | — |
Contacts
Public ContactSophie Spoorenberg
UMCG Afdeling Gezondheidswetenschappen De Brug, 6e verdieping, huispostcode FA10 Antwoordnummer 280
Outcome results
None listed