Facing Frailty: Exploring the Effectiveness of Integrated Care for Frail Older People

This thesis aimed to explore the (cost-)effectiveness of preventive, integrated care for community-dwelling frail older people. The first part of this thesis focused on the effectiveness and cost-effectiveness of a specific preventive integrated care intervention, the Walcheren Integrated Care Model (WICM). The second part of this thesis critically reflected on the concepts and methodologies used to explore the (cost-)effectiveness of integrated care for frail older people. This second part included a systematic review and an exploration of the effectiveness of integrated care for six profiles of frail older people

Cost-effectiveness of the 'Walcheren Integrated Care Model' intervention for community-dwelling frail elderly

Background.: An important aim of integrated care for frail elderly is to generate more cost-effective health care. However, empirical research on the cost-effectiveness of integrated care for community-dwelling frail elderly is limited. Objective.: This study reports on the cost-effectiveness of the Walcheren Integrated Care Model (WICM) after 1

Comparing patients’ and other stakeholders’ preferences for outcomes of integrated care for multimorbidity: a discrete choice experiment in eight European countries

Objectives To measure relative preferences for outcomes of integrated care of patients with multimorbidity from eight European countries and compare them to the preferences of other stakeholders within these countries. Design A discrete choice experiment (DCE) was conducted in each country, asking respondents to choose between two integrated care programmes for persons with multimorbidity. Setting Preference data collected in Austria (AT), Croatia (HR), Germany (DE), Hungary (HU), the Netherlands (NL), Norway (NO), Spain (ES), and UK. Participants Patients with multimorbidity, partners and other informal caregivers, professionals, payers and policymakers. Main outcome measures Preferences of participants regarding outcomes of integrated care described as health/well-being, experience with care and cost outcomes, that is, physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and total costs. Each outcome had three levels of performance. Results 5122 respondents completed the DCE. In all countries, patients with multimorbidity, as well as most other stakeholder groups, assigned the (second) highest preference to enjoyment of life. The patients top-three most frequently included physical functioning, psychological well-being and continuity of care. Continuity of care also entered the top-three of professionals, payers and policymakers in four countries (AT, DE, HR and HU). Of the five stakeholder groups, preferences of professionals differed most often from preferences of patients. Professionals assigned lower weights to physical functioning in AT, DE, ES, NL and NO and higher weights to person-centredness in AT, DE, ES and HU. Payers and policymakers assigned higher weights than patients to costs, but these weights were relatively low. Conclusion The well-being outcome enjoyment of life is the most important outcome of integrated care in multimorbidity. This calls for a greater involvement of social and mental care providers. The difference in opinion between patients and professionals calls for shared decision-making, whereby efforts to improve well-being and person-centredness should not divert attention from improving physical functioning

Integrated care for frail elderly: A qualitative study of a promising approach in the netherlands

Introduction: Increasingly, frail elderly need to live at home for longer, relying on support from informal caregivers and community-based health-and social care professionals. To align care and avoid fragmentation, integrated care programmes are a

Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: An individual participant data meta-analysis

Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective

Facing Frailty : Exploring the effectiveness of integrated care for frail older people

markdownabstractIntegrated care is advocated as a promising solution to overcome barriers in the fragmented health care system for complex populations as frail older people. However, it remains unclear whether integrated care can meet the high and diverse expectations. The aim of this thesis was therefore to explore the (cost-)effectiveness of preventive, integrated care for community-dwelling frail older people. Part A of this thesis focuses on the Walcheren Integrated Care Model (WICM), a comprehensive intervention combining evidence-based elements, involving geriatric assessments, case management, multidisciplinary teams, a single entry point, multidisciplinary protocols and discussions, web-based patient files, and a provider network into one intervention. It focuses on the entir