The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP) for older adults with diabetes and multiple chronic conditions: study protocol for a randomized controlled trial
Authors: Ploeg Jenny , Markle-Reid Maureen , Valaitis Ruta , Fisher Kathryn , Ganann Rebecca , Blais Johanne , Chambers Tracey , Connors Robyn , Gruneir Andrea , Légaré France , MacIntyre Janet , Montelpare William , Paquette Jean-Sébastien , Poitras Marie-Eve , Riveroll Angela , Yous Marie-Lee ,   on behalf of the ACHRU-CPP Research Team, Ploeg Jenny , Markle-Reid Maureen , Valaitis Ruta , Fisher Kathryn , Ganann Rebecca , Blais Johanne , Gruneir Andrea , Légaré France , MacIntyre Janet , Montelpare William , Paquette Jean-Sébastien , Poitras Marie-Eve , Riveroll Angela , Charif Ali Ben , Eurich Dean , Gafni Amiram , Lewis Gary , Mansell Lynne , Pritchard Janet , Sherifali Diana , Thabane Lehana , Upshur Ross , Williamson Tyler , Northwood Melissa , Sadowski Cheryl , Tang Frank 
Published: February 2022

Abstract
Background
Older adults (≥65 years) with diabetes and multiple chronic conditions (MCC) (> 2 chronic conditions) experience reduced function and quality of life, increased health service use, and high mortality. Many community-based self-management interventions have been developed for this group, however the evidence for their effectiveness is limited. This paper presents the protocol for a randomized controlled trial (RCT) comparing the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) to usual care in older adults with diabetes and MCC and their caregivers.

Methods
We will conduct a cross-jurisdictional, multi-site implementation-effectiveness type II hybrid RCT. Eligibility criteria are: ≥65 years, diabetes diagnosis (Type 1 or 2) and at least one other chronic condition, and enrolled in a primary care or diabetes education program. Participants will be randomly assigned to the intervention (ACHRU-CPP) or control arm (1:1 ratio). The intervention arm consists of home/telephone visits, monthly group wellness sessions, multidisciplinary case conferences, and system navigation support. It will be delivered by registered nurses and registered dietitians/nutritionists from participating primary care or diabetes education programs and program coordinators from community-based organizations. The control arm consists of usual care provided by the primary care setting or diabetes education program. The primary outcome is the change from baseline to 6 months in mental functioning. Secondary outcomes will include, for example, the change from baseline to 6 months in physical functioning, diabetes self-management, depressive symptoms, and cost of use of healthcare services. Analysis of covariance (ANCOVA) models will be used to analyze all outcomes, with intention-to-treat analysis using multiple imputation to address missing data. Descriptive and qualitative data from older adults, caregivers and intervention teams will be used to examine intervention implementation, site-specific adaptations, and scalability potential.

Discussion
An interprofessional intervention supporting self-management may be effective in improving health outcomes and client/caregiver experience and reducing service use and costs in this complex population. This pragmatic trial includes a scalability assessment which considers a range of effectiveness and implementation criteria to inform the future scale-up of the ACHRU-CPP.

Trial registration
Clinical Trials.gov Identifier NCT03664583. Registration date: September 10, 2018.