Protocol for Multi-site Evaluation of New Community-based Frailty Programme
Condition: Frailty; Frail Elderly Syndrome; Frailty Syndrome
MeSH terms: Syndrome; Frailty
Study type: Observational

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.
    


Intervention name(s): There is no active intervention as this is a service evaluation
Intervention type(s): Other
Intervention description(s): There is no active intervention as this is a service evaluation
Observational model: Other
Time perspective: Prospective
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 .
      
Keywords: frailty care; comprehensive geriatric assessment; care coordination; multidisciplinary team care