Evaluation of a technology-enhanced integrated care model for frail older persons: protocol of the SPEC study, a stepped-wedge cluster randomized trial in nursing homes

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Abstract

Background

Limited evidence exists on the effectiveness of the chronic care model for people with multimorbidity. This study aims to evaluate the effectiveness of an information and communication technology- (ICT-)enhanced integrated care model, called Systems for Person-centered Elder Care (SPEC), for frail older adults at nursing homes.

Methods/Design

SPEC is a prospective stepped-wedge cluster randomized trial conducted at 10 nursing homes in South Korea. Residents aged 65 or older meeting the inclusion/exclusion criteria in all the homes are eligible to participate. The multifaceted SPEC intervention, a geriatric care model guided by the chronic care model, consists of five components: comprehensive geriatric assessment for need/risk profiling, individual need-based care planning, interdisciplinary case conferences, person-centered care coordination, and a cloud-based information and communications technology (ICT) tool supporting the intervention process. The primary outcome is quality of care for older residents using a composite measure of quality indicators from the interRAI LTCF assessment system. Outcome assessors and data analysts will be blinded to group assignment. Secondary outcomes include quality of life, healthcare utilization, and cost. Process evaluation will be also conducted.

Discussion

This study is expected to provide important new evidence on the effectiveness, cost-effectiveness, and implementation process of an ICT-supported chronic care model for older persons with multiple chronic illnesses. The SPEC intervention is also unique as the first registered trial implementing an integrated care model using technology to promote person-centered care for frail older nursing home residents in South Korea, where formal LTC was recently introduced.

Trial registration

10.1186/ISRCTN11972147

Related collections

Most cited references 32

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Evidence on the Chronic Care Model in the new millennium.

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Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study.

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This study was undertaken to determine the prevalence of mental disorders among obstetric-gynecologic patients and to assess the validity and utility of the PRIME-MD Patient Health Questionnaire (PHQ) in this population. A total of 3000 patients were assessed by 63 clinicians at seven obstetrics-gynecology outpatient care sites. The main outcome measures were PRIME-MD PHQ diagnoses, psychosocial stressors, independent diagnoses made by mental health professionals, functional status measures, disability days, health care use, and treatment or referral decisions. Current mental disorders were fairly prevalent, present in 1 in 5 obstetric-gynecologic patients. Patients with PRIME-MD PHQ diagnoses had more functional impairment, disability days, health care use, and psychosocial stressors than did patients without PRIME-MD PHQ diagnoses (P <.005 for all measures). Although most clinicians judged the PRIME-MD PHQ to be useful in management decisions, the questionnaire diagnosis of mental disorder rarely led to therapeutic intervention. The PRIME-MD PHQ is a useful instrument for the assessment of mental disorders, functional impairment, and recent psychosocial stressors in the busy obstetrics-gynecology setting.

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Author and article information

Contributors

Hongsoo Kim: 822-880-2723 , hk65@snu.ac.kr

Yeon-Hwan Park: hanipyh@snu.ac.kr

Young-il Jung: extra012@snu.ac.kr

Hyoungshim Choi: hyoungshim@ysu.ac.kr

Seyune Lee: seyunel@gmail.com

Gi-Soo Kim: gisoo1989@naver.com

Dong-wook Yang: assarong@snu.ac.kr

Myunghee Cho Paik: myungheechopaik@snu.ac.kr

Tae-Jin Lee: tjlee@snu.ac.kr

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 18 April 2017

Publication date PMC-release: 18 April 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 88

Affiliations

[1 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, Department of Public Health Science at Graduate School of Public Health, , Institute of Aging, Institute of Health and Environment, Seoul National University, ; 1 Gwanak-ro, Gwanak-gu, Seoul South Korea

[2 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, College of Nursing, the Research Institute of Nursing Science, , Seoul National University, ; Daehakro 103, Jongno-Gu, Seoul South Korea

[3 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, Institute of Health and Environment, , Seoul National University, ; 1 Gwanak-ro, Gwanak-gu, Seoul South Korea

[4 ]ISNI 0000 0004 0642 3629, GRID grid.444050.1, , Youngsan University, College of Nursing, Yangsan Campus, ; 288 Junam-ro, 50510 Yangsan, Gyeongnam South Korea

[5 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, Department of Public Health Science at Graduate School of Public Health, , Seoul National University, ; 1 Gwanak-ro, Gwanak-gu, Seoul South Korea

[6 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, College of Natural Sciences, Department of Statistics, , Seoul National University, ; 1 Gwanak-ro, Gwanak-gu, Seoul South Korea

[7 ]ISNI 0000 0004 0470 5905, GRID grid.31501.36, Department of Public Health Science at Graduate School of Public Health, , Institute of Health and Environment, Seoul National University, ; 1 Gwanak-ro, Gwanak-gu, Seoul South Korea

Article

Publisher ID: 459

DOI: 10.1186/s12877-017-0459-7

PMC ID: 5395967

PubMed ID: 28420324

SO-VID: cbf7b231-aa09-40c1-8fa0-bb29006aaa5c

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 17 December 2016

Date accepted : 7 March 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003710, Korea Health Industry Development Institute;

Award ID: HI13C2250

Award Recipient : Hongsoo Kim

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: chronic care model,geriatric care model,long-term care,technology,stepped-wedge trials,quality of care,quality of life,economics,elderly,process evaluation

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: chronic care model, geriatric care model, long-term care, technology, stepped-wedge trials, quality of care, quality of life, economics, elderly, process evaluation

Evaluation of a technology-enhanced integrated care model for frail older persons: protocol of the SPEC study, a stepped-wedge cluster randomized trial in nursing homes

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Abstract

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Discussion

Trial registration

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Hearing Loss and Restoration

Most cited references 32

Evidence on the Chronic Care Model in the new millennium.

Improving the sensitivity of the Barthel Index for stroke rehabilitation.

Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study.

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