Implementation and impact of the World Health Organization integrated care for older people (ICOPE) program in China: a randomised controlled trial

Abstract

Background Fragmentation of services increases health and social care burden as people live longer with higher prevalence of diseases, frailty and dependency. Local evidence for implementing person-centred integrated care is urgently needed to advance practice and policies to achieve healthy ageing. Objective To test the feasibility and impact of World Health Organization's (WHO) Integrated Care for Older People (ICOPE) approach in China. Design A randomised controlled trial examining the feasibility of implementing ICOPE approach, evaluating its impact on health outcomes and health resource utilisation. Setting Primary care setting in urban and suburban communities of Chaoyang District, Beijing, China. Subjects Community-dwelling older adults screened as at-risk of functional declines and randomised into intervention (537) and control (1611) groups between September 2020 and February 2021. Methods A 6-month intervention program following WHO's ICOPE care pathways implemented by integrated care managers compared to standard available care. Results After 1 to 1 propensity score matching, participants in intervention and control groups (totally 938) had comparable baseline characteristics, demonstrated feasibility of implementing ICOPE with satisfaction by participants (97–99%) and providers (92–93%). All outcomes showed improvements after a 6-month intervention, while statistically significant least-squares mean differences (control-intervention) in vitality (Mini-Nutritional Assessment Short Form to measure vitality, −0.21, 95% CI, −0.40–0.02), mobility (Short Physical Performance Battery to measure mobility, −0.29, 95% CI, −0.44–0.14) and psychological health (Geriatric Depression Scale five items to measure psychological health, 0.09, 95% CI, 0.03–0.14) were observed (P < 0.05). Conclusions It is feasible to localise and implement WHO’s ICOPE approach in regions with fragmented resources such as China. Preliminary evidence supports its acceptance among key stakeholders and impact on health outcomes.