Embrace, a model for integrated elderly care: study protocol of a randomized controlled trial on the effectiveness regarding patient outcomes, service use, costs, and quality of care

Abstract

BackgroundOngoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care.Methods/DesignThe CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program – combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period.DiscussionThis study could provide evidence for the effectiveness of Embrace.Trial registrationThe Netherlands National Trial Register NTR3039

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“…In case of missing data, elderly were interviewed via the telephone to complete the questionnaire. For more details about Embrace, the person‐centered, and integrated care service, see the studies of Spoorenberg et al (, ) and Uittenbroek et al (,b). Informed consent was obtained from all participants, and the study was performed in accordance with the Declaration of Helsinki.…”

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“…Participants were recruited from January through November 2014 by means of advertisement, leaflets, and recruitment during meetings of Embrace, a population-based program for integrated elderly care, where community-dwelling older adults could receive information on all aspects of aging (29). …”

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“…Subsequently, the following limits were imposed: i) text availability: free full text; ii) publication dates: 5 years; and iii) species: human, with the exclusion of 94 studies, for a total of 14 studies useful for the revision (Table 2). [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] …”