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

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.

Nurse-Initiated Fall and Osteoporosis Screening for Older Adults in the Emergency Department

“…TFMC is a general practice clinic we partnered with as part of a larger GSH pilot program under GERI. The aim of the program is to provide affordable integrated care for frail older adults in the community [ 16 ]. There is support from our hospital’s geriatricians, and patients referred to TFMC for follow-up also benefit from governmental subsidies for select tests and medications under this scheme so that care can remain affordable and patients can remain in the community.…”

“…As part of a larger Geriatric Services Hub (GSH) project with the Geriatric Education and Research Institute (GERI), we partnered with a general practice clinic, the Tampines Family Medicine Clinic (TFMC) [ 16 ], aiming to provide affordable integrated care for frail older adults in the community.…”

Barriers and Enablers to a Hospital-to-Home, Combined Exercise and Nutrition, Self-Managed Program for Pre-Frail and Frail Hospitalised Older Adults

“…Purposive sampling was employed to recruit hospitalised older adults that were pre-frail or frail, as determined by the Edmonton Frail Scale (EFS) [ 17 ], and that took part in a hospital-to-home, self-managed, combined exercise and nutrition intervention program between September 2020 and June 2021. Purposive sampling was chosen because it can yield the most appropriate information by selecting a population that is most relevant to answer the research questions in this study, i.e., older adults interviewed were the most appropriate to discuss their experiences of barriers and enablers to the program, as they were participants [ 18 , 19 ].…”

Geriatric Services Hub – A Collaborative Frailty Management Model between The Hospital and Community Providers

“…Against this backdrop, Singapore’s Ministry of Health (MOH) initiated the Geriatric Service Hub (GSH) to enhance identification and management of frailty in the community. The main goals of GSH are to increase health-span, minimise disability and promote ageing in place ( 12 ). The GSH was developed in anticipation of the growing complex care needs of a rapidly ageing population.…”