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

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

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.

Study Overview

• Status: Completed
• Conditions: Frail Elderly Syndrome; Frailty; Frailty Syndrome
• Intervention / Treatment: Other: There is no active intervention as this is a service evaluation

• Study Type: Observational
• Enrollment (Actual): 335

Contacts and Locations

Study Locations

• Singapore
  • Singapore, Singapore, 768024
    • Geriatric Education and Research Institite

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 99 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• 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 .

Description

1. 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

2. 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

3. 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

4. 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
5. 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

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
GSH Participants; 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; There is no active intervention as this is a service evaluation
Policy owners, implementers & care partners, health and social care professionals; 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; There is no active intervention as this is a service evaluation

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Geriatric Education and Research Institute
• Collaborators: Singapore General Hospital; Changi General Hospital; Sengkang General Hospital; Alexandra Hospital; Ng Teng Fong General Hospital
• Investigators: Principal Investigator: Woan Shin Tan, PhD, Joint Faculty and PI

Publications and helpful links

General Publications

• Tan WS, Nai ZL, Tan HTR, Nicholas S, Choo R, Ginting ML, Tan E, Teng PHJ, Lim WS, Wong CH, Ding YY; Geriatric Services Hub Programme Group. Protocol for a mixed-methods and multi-site assessment of the implementation process and outcomes of a new community-based frailty programme. BMC Geriatr. 2022 Jul 15;22(1):586. doi: 10.1186/s12877-022-03254-6.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2019
• Primary Completion (Actual): September 30, 2022
• Study Completion (Actual): September 30, 2022

Study Registration Dates

• First Submitted: April 12, 2021
• First Submitted That Met QC Criteria: April 26, 2021
• First Posted (Actual): April 29, 2021

Study Record Updates

• Last Update Posted (Estimate): February 21, 2023
• Last Update Submitted That Met QC Criteria: February 20, 2023
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: care coordination; comprehensive geriatric assessment; frailty care; multidisciplinary team care
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Syndrome; Frailty
• Other Study ID Numbers: 2019/00925

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The information will not be shared due to confidentiality

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No