Protocol for Multi-site Evaluation of New Community-based Frailty Programme

NCT04866316 | Completed

• 1 other identifier: 2019/00925
• Study Type: observational
• Target: 335
• Locations: 1 country
• Sites: 1

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.

Conditions

Frailty; Frail Elderly Syndrome; Frailty Syndrome

Keywords

frailty care; comprehensive geriatric assessment; care coordination; multidisciplinary team care

Outcome Measures

Primary Outcomes (2)

• Functional status

  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.

  April 2019 - September 2022

• Health outcomes

  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).

  April 2019 - September 2022

Secondary Outcomes (3)

• Utilisation of appropriate services

  April 2019 - September 2022

• Patient Satisfaction

  April 2019 - September 2022

• Shared decision making/ engagement

  April 2019 - September 2022

Study Arms (2)

GSH Participants

Qualitative - Semi-structured focus group discussions with care recipients Quantitative - Pre-test post-test design using survey-based data collection Quantitative - Retrospective cohort design with propensity score matched comparators

Other: There is no active intervention as this is a service evaluation

Policy owners, implementers & care partners, health and social care professionals

Qualitative - Semi-structured in-depth interview with key policy and programme decision-makers Qualitative - Semi-structured focus group discussions with health and social care professionals Qualitative - Participant observations Quantitative - Longitudinal monitoring of process indicators

Other: There is no active intervention as this is a service evaluation

Interventions

There is no active intervention as this is a service evaluation OTHER

There is no active intervention as this is a service evaluation

GSH Participants; Policy owners, implementers & care partners, health and social care professionals

Eligibility Criteria

• Age: 21 Years - 99 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Given that the study involves a mixed method evaluation evaluation methodology, to gain a comprehensive understanding of the factors influencing the effectiveness of the implementation approaches adopted by the GSH programmes, and their impacts, the study population will comprise of professional stakeholders playing critical roles in the development and implementation of the new model of community-based frailty care, and the participants of the GSH programme services .

You may qualify if:

• 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

You may not qualify if:

• Qualitative Focus group discussions/ Implementation team
• Individuals with time funded through the programme who have been providing services in the GSH for at least six month
• Qualitative Focus group discussions/ partner organizations
• healthcare professionals and administrative staff who provided services within the new programme for at least six months
• Qualitative Focus group discussions/ GSH participants
• Participants who receive care under the new model for at least three months
• Quantitative survey questionnaire / GSH participants
• Patients that meet the necessary clinical criteria for enrollment in the respective GSH programme
• Age: 65 and above
• Clinical Frailty Score (CFS): 4-7

Sponsors & Collaborators

• Geriatric Education and Research Institute: lead
• Alexandra Hospital: collaborator
• Changi General Hospital: collaborator
• Ng Teng Fong General Hospital: collaborator
• Sengkang General Hospital: collaborator
• Singapore General Hospital: collaborator

Study Sites (1)

Geriatric Education and Research Institite

Singapore, 768024, Singapore

Location

Related Publications (1)

• Tan WS, Nai ZL, Tan HTR, Nicholas S, Choo R, Ginting ML, Tan E, Teng PHJ, Lim WS, Wong CH, Ding YY; Geriatric Services Hub Programme Group. Protocol for a mixed-methods and multi-site assessment of the implementation process and outcomes of a new community-based frailty programme. BMC Geriatr. 2022 Jul 15;22(1):586. doi: 10.1186/s12877-022-03254-6.

  PMID: 35840898 DERIVED

MeSH Terms

Conditions

Frailty

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Woan Shin Tan, PhD

  Joint Faculty and PI

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 12, 2021
• First Posted: April 29, 2021
• Study Start: April 1, 2019
• Primary Completion: September 30, 2022
• Study Completion: September 30, 2022
• Last Updated: February 21, 2023

Record last verified: 2022-08

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)