Measured outcomes of chronic care programs for older adults: a systematic review

Drouin, Heather; Walker, Jennifer; McNeil, Heather; Elliott, Jacobi; Stolee, Paul

doi:10.1186/s12877-015-0136-7

Cited by 27 publications

(24 citation statements)

References 34 publications

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“…More consistent outcome assessment frameworks are needed. Measurements of outcomes at the health system level is rare, at the population or community level even more missing [14]. Although (informal) caregivers are frequently involved in chronic care, specific outcome measurements targeting family members or friends are missing [14].…”

Section: Improved Outcome and Evaluationmentioning

confidence: 99%

“…validated outcome measures, targeting the heterogeneous population of elderly patients, the community they live in as well as their caregivers [14] are needed to improve our understanding of the dynamic and diversified shape of integrated care concepts [15]. Consequently, EU-wide strategies and recommendations for regional implementation of target-group specific chronic care models are still lacking.…”

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confidence: 99%

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The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

Timpel

Lang²,

Wens

et al. 2020

Int J Integr Care

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BackgroundA growing number of EU citizens suffers from diabetes, posing an emerging health, social and economic burden in the EU [1]. This burden is mostly driven by type 2 diabetes mellitus (T2DM), which is increasingly diagnosed at younger age and leads to a rising number of adults with T2DM aged 65 and older [1]. Due to these rising numbers in diabetes prevalence a growing number of patients faces accompanying comorbidities as well as complex needs [2][3][4][5]. However, many care systems are historically built on separate sectors (health vs. social care, in-vs. outpatient care). This traditional acute and episodic focus of care is inadequate to effectively meet the complex needs of patients as it increases the risk of care fragmentation and loss of information [6,7]. Although these circumstances are repetitively part of health policy initiatives [8,9], there is still an institutional and regulatory separation between health and social care services, as well as between ambulatory and inpatient care [10].Integrated care is said to improve outcomes of care by linking services of providers along the continuum of care and thus overcoming issues of fragmentation [11]. Back in 1996, Ed Wagner developed the Chronic Care Model (CCM), which became a cornerstone to improve care delivery for chronically ill patients. The CCM comprises the following six components: (1) community, (2) health system, (3) self-management support, (4) delivery system design, (5) decision support and (6) clinical information systems [12]. Ever since, different initiatives developed new models targeting specific weaknesses of the initial CCM.However, recent analysis uncovered that the understanding of established models' impact on chronic disease management is limited [13]. This is especially true for the effectiveness and applicability of chronic care models in different populations and settings [13]. Additionally, on behalf of the MANAGE CARE Study Group Background: Most current care models are disease-or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. Method: An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model. Results: The developed 'MANAGE CARE MODEL' includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care. Conclusion: The MANAGE CARE MODEL provides...

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Section: Improved Outcome and Evaluationmentioning

confidence: 99%

mentioning

confidence: 99%

The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

Timpel

Lang²,

Wens

et al. 2020

Int J Integr Care

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“…Excluding the five studies that were reviews, 414,418,429,462,463 38 studies were carried out in the USA, 415,419,[423][424][425][426][427][431][432][433][434]436,438,[440][441][442][443][444]446,447,449,450,[452][453][454][456][457][458][459][460][461][465][466][467][468]472,474,476 six in Australia, 420,421,428,430,439,448 three in multiple sites (one in 30 countries, 464…”

Section: Countriesmentioning

confidence: 99%

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

Hanratty

Craig

Spilsbury

et al. 2019

Health Serv Deliv Res

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BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Specific models of valuebased healthcare, such as pay-for-performance, have shown effectiveness in certain diseases or chronic conditions but not overall. 3 Moreover, prevalent chronic comorbidities in older adults [1] make it hard to measure variations in health outcomes. More 'function-centric' aging medicine is crucial to handling the diversity and complexity of health care for older people and promoting healthy aging.…”

Section: Introductionmentioning

confidence: 99%

“…[2] Without such tools, it is difficult for policymakers and health professionals to choose interventions effective in improving care quality. [3] The ICHOM Standard Set of health outcomes for older persons will conduce to supplanting piecemeal care of older persons with a more holistic approach.…”

Section: Introductionmentioning

confidence: 99%

First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

Lee

Peng

Lin

et al. 2019

Preprint

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Background: Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset. Methods: The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions who received value-based healthcare services between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results: Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease severity (OR 0.40, 95% CI 0.21–0.76, p=0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p=0.014) were less likely to have high value-based healthcare status. Conclusions: The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to patient-focused goals. This study identified advanced age, chronic disease and cognitive impairment as important barriers to achieving high value-based healthcare status.

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Measured outcomes of chronic care programs for older adults: a systematic review

Cited by 27 publications

References 34 publications

The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

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