Community and in-home models

Models of integrated care for older people with frailty: a horizon scanning review

OBJECTIVES

Frailty, a multifaceted geriatric condition, is an emerging global health problem. Integrated care models designed to meet the complex needs of the older people with frailty are required. Early identification of innovative models may inform policymakers and other stakeholders of service delivery alternatives they can introduce and locally adapt so as to tackle system fragmentation and lack of coordination. This study used horizon scanning methodologies to systematically search for, prioritise and assess new integrated care models for older people with frailty and investigated experts' views on barriers and facilitators to the adoption of horizon scanning in health services research.

METHODS

A four-step horizon scanning review was performed. Frailty-specific integrated care models and interventions were identified through a review of published literature supplemented with grey literature searches. Results were filtered and prioritised according to preset criteria. An expert panel focus group session assessed the prioritised models and interventions on innovativeness, impact and potential for implementation. The experts further evaluated horizon scanning for its perceived fruitfulness in aiding decision-making.

RESULTS

Nine integrated care models and interventions at system level (n=5) and community level (n=4) were summarised and assessed by the expert panel (n=7). Test scores were highest for the Walcheren integrated care model (system-based model) and EuFrailSafe (community-based intervention). The participants stated that horizon scanning as a decision-making tool could aid in assessing knowledge gaps, criticising the status quo and developing new insights. Barriers to adoption of horizon scanning on individual, organisational and wider institutional level were also identified.

CONCLUSION

Study findings demonstrated that horizon scanning is a potentially valuable tool in the search for innovative service delivery models. Further studies should evaluate how horizon scanning can be institutionalised and effectively used for serving this purpose.

Improving Hypertension Control in a Population of Low-Income Frail Older Adults

We evaluated hypertension management among enrollees in Just for Us (JFU)—an approach to providing coordinated, in-home care to medically fragile, low-income older or disabled adults living independently. The sample was 264 JFU patients who enrolled between January 1, 2002 and December 31, 2004, lived in a JFU building, and had blood pressure (BP) recorded 1 year from baseline. BP change was analyzed with paired t tests, and control status change with McNemar’s. Characteristics associated with change were explored with ordinary least squares (OLS) regression. For the 225 individuals with hypertension at baseline, average systolic pressure dropped 7.73 mmHg ( p < .001) and diastolic 4.41 mmHg ( p < .001). In the same group, 57.4% of those not in control at baseline were in control 1 year later; 19.7% of those in control at baseline moved out of control ( p < .001). BP declined across subgroups and was greater for African Americans, the predominant racial group. Additional evaluation of such models is warranted.