Protocol for a mixed-methods and multi-site assessment of the implementation process and outcomes of a new community-based frailty programme

Woan Shin Tan, Ze Ling Nai, Hwee Teng Robyn Tan, Sean Nicholas, Robin Choo, Mimaika Luluina Ginting, Edward Tan, Poh Hoon June Teng, Wee Shiong Lim, Chek Hooi Wong, Yew Yoong Ding, Geriatric Services Hub Programme Group, Santhosh Kumar Seetharaman, Christopher Tsung Chien Lien, Barbara Helen Rosario, Shou Lin Low, Arron Seng Hock Ang, Mei Foon Yap, Milawaty Nurjono, Lydia Au, Lian Leng Low, Su Fee Lim, Esther Li Ping Lim, Laura Bee Gek Tay, Germaine Hwui San Chng, Melvin Peng Wei Chua, Yee Sien Ng, Woan Shin Tan, Ze Ling Nai, Hwee Teng Robyn Tan, Sean Nicholas, Robin Choo, Mimaika Luluina Ginting, Edward Tan, Poh Hoon June Teng, Wee Shiong Lim, Chek Hooi Wong, Yew Yoong Ding, Geriatric Services Hub Programme Group, Santhosh Kumar Seetharaman, Christopher Tsung Chien Lien, Barbara Helen Rosario, Shou Lin Low, Arron Seng Hock Ang, Mei Foon Yap, Milawaty Nurjono, Lydia Au, Lian Leng Low, Su Fee Lim, Esther Li Ping Lim, Laura Bee Gek Tay, Germaine Hwui San Chng, Melvin Peng Wei Chua, Yee Sien Ng

Abstract

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 success. However, many of these care models' implementation insights are contextual and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care model in Singapore that focuses on identifying and managing frailty in the community. It includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multi-disciplinary team. This study aims to gain insights into the factors influencing the development and implementation of the GSH. We also aim to determine the programme's effectiveness through patient-reported health-related outcomes. Finally, we will conduct a healthcare utilisation and cost analysis using a propensity score-matched comparator group.

Methods: We will adopt a mixed-methods approach that includes a qualitative evaluation among key stakeholders and participants in the programme, through in-depth interviews and focus group discussions. The main topics covered include factors that affected the development and implementation of each programme, operations and other contextual factors that influenced implementation outcomes. The quantitative evaluation monitors each programme's care process through quality indicators. It also includes a multiple-time point survey study to compare programme participants' pre- and post- outcomes on patient engagement, healthcare services experiences, health status and quality of life, caregiver burden and societal costs. A retrospective cohort study will compare 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 increase the accessibility of essential services to frail older adults and provide comprehensive care. This evaluation study will provide invaluable insights into both the process and outcomes of the GSH and inform the design of similar programmes targeting frail older adults.

Trial registration: ClinicalTrials.gov Identifier NCT04866316 . Date of Registration April 26, 2021. Retrospectively registered.

Keywords: Care coordination; Comprehensive geriatric assessment; Frailty care; Multi-disciplinary team care.

Conflict of interest statement

The authors declare no conflict of interest with respect to the research, authorship and/or publication of this article.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Functions of the Geriatric Services Hub Intervention

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