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

Study Overview
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Brief Summary
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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.

Official Title
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Protocol for a Mixed Methods and Multi-site Assessment of the Implementation Process and Outcomes of a New Community-based Frailty Programme

Conditions
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Frailty, Frail Elderly Syndrome, Frailty Syndrome

Intervention / Treatment
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* Other: There is no active intervention as this is a service evaluation


Participation Criteria
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Eligibility Criteria
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Qualitative In depth Interviews/ Policy owners & administrators Inclusion Criteria: 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 Exclusion Criteria: Do not meet inclusion criteria above Qualitative Focus group discussions/ Implementation team Inclusion Criteria: Individuals with time funded through the programme who have been providing services in the GSH for at least six month Exclusion Criteria: Do not meet inclusion criteria above Qualitative Focus group discussions/ partner organizations Inclusion Criteria: healthcare professionals and administrative staff who provided services within the new programme for at least six months Exclusion Criteria: Do not meet inclusion criteria above Qualitative Focus group discussions/ GSH participants Inclusion Criteria: Participants who receive care under the new model for at least three months Exclusion Criteria: Do not meet inclusion criteria above Quantitative survey questionnaire / GSH participants Inclusion Criteria: Patients that meet the necessary clinical criteria for enrollment in the respective GSH programme Age: 65 and above Clinical Frailty Score (CFS): 4-7 Exclusion Criteria: Do not meet inclusion criteria above

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| GSH Participants<br>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<br>* There is no active intervention as this is a service evaluation<br>|
| Policy owners, implementers & care partners, health and social care professionals<br>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<br>* There is no active intervention as this is a service evaluation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Utilisation of appropriate services | GSH sites offer a range of medical, social and other services through either direct provision or referrals. Given that the model is intended to bridge service gaps (conduct of Comprehensive Geriatric Assessment/ CGA in the community), in the short-term, we hypothesis an increase in the utilisation of appropriate services (rehabilitation, ambulatory services) in this time-limited programme. Utilisation of services will be measured using Client Service Receipt Inventory (CSRI). | April 2019 - September 2022 | 
| Patient Satisfaction | GSH participants are expected to benefit from the comprehensive package of health and social services and multidisciplinary team approach. With better care coordination and improved access, it is likely to elicit a higher level of satisfaction relative to comparator groups. Patient satisfaction will be measured using the Consumer Assessment of Healthcare Providers and System Clinician & Group Survey Version 3.0 (CG-CAHPS) tool. | April 2019 - September 2022 | 
| Shared decision making/ engagement | Education of the client about self-care, and making decisions about potential care options with inputs from a multidisciplinary team, is expected to result in higher level of shared decision making and engagement relative to comparator groups. Shared decision making/ engagement will be measured using the collaboRATE For Patient - 5-point anchor scale, and 13-item Patient Activation Measure (PAM-13). | April 2019 - September 2022 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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frailty care, comprehensive geriatric assessment, care coordination, multidisciplinary team care