Evaluation of the implementation of an integrated nurse-led model of care for community-based senior citizens in Canton Basel-Landschaft
Introduction In Europe, the older population is increasing with an old-age dependency ratio rising up to 50% by 2050 (1–3). Advancing age is associated with various health problems, such as multimorbidity, functional dependencies and disabilities. (4,5). Although the majority of older people prefers to age in their own house, the care of home-dwelling older persons with multiple health problems is often complex due to a lack of coordination between all health and social care providers involved in the care delivery. (4,6,7). To overcome this fragmentation of care, integrated care models, characterized by care coordination and a multidisciplinary team approach, should be implemented. Integrated care is centered towards the needs of the older population, can improve patient, service and organizational outcomes and reduce health care costs (8). In response to these challenges the canton Basel-Landschaft has established a new legislation (i.e.Altersbetreuungs- und Pflegegesetz, applicable since 01/01/2018) that demands a reorganisation of the Canton in larger care regions. (9). In each region, a nurse-led Informations- und Beratungsstelle to provide ageing-related information, health care advice and case-management, should be implemented. This PhD project is part of the overall INSPIRE project, which aims to develop, implement and evaluate a nurse-led community-based care model for senior citizens in canton Basel-Landschaft. PhD project aims The PhD project seeks primarily to determine the impact on patient-centred and coordinated care for home-dwelling frail older adults at 6 months follow-up compared to usual care. The secondary objectives of the study include: - To determine the impact of a nurse-led integrated care model (compared to usual care) on health-related quality of life, treatment burden, activities of daily living (ADL), incidence of emergency department (ED) visits, hospital admission rate, nursing home admission rate, as well as quality adjusted life years (QALYs) up to 6 months follow-up. - To compare the number of potentially inappropriate medications (PIMs) before and after the intervention. Methodology The INSPIRE project uses a hybrid type I effectiveness-implementation design. This means that while the primary focus is to measure program effectiveness of the care model, our secondary focus will be to simultaneously study the implementation process, strategies and outcomes. First, a feasibility study will be conducted to evaluate the acceptability and feasibility prior to full program implementation. The feasibility group will include the first 30 older adults who agree to participate in the study and receive the intervention. Data will be collected from the participating older adults as well as participating health and social care providers to measure the implementation outcomes and assess the feasibility of the study. A pre-post study will be conducted to measure program effectiveness. To recruit participants, all home-based older adults aged 75+ living in the two care regions and assisting to IBS will be invited to participate in the study, and to be assessed by the Groningen Frailty Indicator (GFI) screening tool which will indicate their geriatric risk profile. Based on interested respondents’ GFI screening results, eligible participants with a GFI > 4 will be followed-up until 6 months. Data will be collected from participating older adults who are identified as “frail” (based on their geriatric risk profile) and receive the intervention. Primary and secondary outcome measures will be taken at baseline and after 3- and 6- months.