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Tokson M, Rahrig H, Green JD. Disease-preventive behaviors and subjective well-being in the COVID-19 pandemic. BMC Psychol 2023; 11:288. [PMID: 37749642 PMCID: PMC10521491 DOI: 10.1186/s40359-023-01316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Safety precautions and activity restrictions were common in the early, pre-vaccine phases of the COVID-19 pandemic. We hypothesized that higher levels of participation in potentially risky social and other activities would be associated with greater life satisfaction and perceived meaning in life. At the same time, prosocial COVID-preventive activities such as mask wearing should enhance life satisfaction. METHOD We assessed the impact of COVID-preventive behaviors on psychological well-being in October 2020. A nationally representative sample of U.S. adults (n = 831) completed a demographic questionnaire, a COVID-related behaviors questionnaire, a Cantril's Ladder item, and the Multidimensional Existential Meaning Scale. Two hierarchical linear models were used to examine the potential impact of COVID-preventive behaviors on life satisfaction and meaning in life while accounting for the influence of demographic factors. RESULTS The study revealed significant positive relationships between COVID-preventive behaviors and subjective well-being. Wearing a mask was significantly associated with higher life satisfaction, while maintaining social distancing of six feet and avoiding large groups were significantly associated with higher perceived meaning in life. Social activities including dining at restaurants and visiting friends and family were also significantly associated with higher life satisfaction and meaning in life, respectively. CONCLUSION The study's findings support the conclusion that disease prevention measures such as social distancing and mask wearing do not reduce, and may enhance, subjective well-being during a pandemic. Utilizing the unique context of the COVID-19 pandemic to examine relationships between behavior and subjective well-being, the study also indicates that shallow or medium-depth social activities are likely to be more central to life satisfaction, whereas narrower, deeper social interactions with friends and family are more important to perceived meaning in life.
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Affiliation(s)
- Matthew Tokson
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT, USA.
| | - Hadley Rahrig
- Psychology Department, University of Wisconsin-Madison, Madison, WI, USA
| | - Jeffrey D Green
- Psychology Department, Virginia Commonwealth University, Richmond, VA, USA
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Lin DY, Cheok TS, Samson AJ, Kaambwa B, Brown B, Wilson C, Kroon HM, Jaarsma RL. A longitudinal validation of the EQ-5D-5L and EQ-VAS stand-alone component utilising the Oxford Hip Score in the Australian hip arthroplasty population. J Patient Rep Outcomes 2022; 6:71. [PMID: 35723750 PMCID: PMC9207851 DOI: 10.1186/s41687-022-00482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the measurement properties of the Oxford Hip Score (OHS), EQ-5D-5L utility index and EQ-5D-5L visual analogue scale (EQ-VAS) in patients undergoing elective total hip arthroplasty in Australia.
Methods In this prospective multi-centre study, the OHS and EQ-5D-5L were collected preoperatively, six weeks (6w) and six months (6m) postoperatively. The OHS, EQ-VAS and EQ-5D-5L index were evaluated for concurrent validity, predictive validity (Spearman's Rho of predicted and observed values from a generalised linear regression model (GLM)), and responsiveness (effect size (ES) and standard response mean (SRM)).
Results 362 patients were included in this analysis for 6w and 269 for 6m. The EQ-5D-5L index showed good concurrent validity with the OHS (r = 0.71 preoperatively, 0.61 at 6w and 0.59 at 6m). Predictive validity for EQ-5D-5L index was similar to OHS when regressed (GLM). Responsiveness was good at 6w (EQ-5D-5L index ES 1.53, SRM 1.40; OHS ES 2.16, SRM 1.51) and 6m (EQ-5D-5L index ES 1.88, SRM 1.70; OHS ES 3.12, SRM 2.24). The EQ-VAS returned poorer results, at 6w an ES of 0.75 (moderate) and SRM 0.8. At 6m the EQ-VAS had an ES of 0.92 and SRM of 1.00. It, however, had greater predictive validity. Conclusions The EQ-5D-5L index and the OHS demonstrate strong concurrent validity. The EQ-5D-5L index demonstrated similar predictive validity at 6w and 6m, and both PROMs had adequate responsiveness. The EQ-VAS should be used routinely together with the EQ-5D-5L index. The EQ-5D-5L is suitable to quantify health-related quality of life in Australian hip arthroplasty patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00482-7.
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Kaneko H, Hanamoto A, Yamamoto-Kataoka S, Kataoka Y, Aoki T, Shirai K, Iso H. Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review. Int J Environ Res Public Health 2022; 19:16113. [PMID: 36498188 PMCID: PMC9741446 DOI: 10.3390/ijerph192316113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Various tools to measure patient complexity have been developed. Primary care physicians often deal with patient complexity. However, their usefulness in primary care settings is unclear. This study explored complexity measurement tools in general adult and patient populations to investigate the correlations between patient complexity and outcomes, including health-related patient outcomes, healthcare costs, and impacts on healthcare providers. We used a five-stage scoping review framework, searching MEDLINE and CINAHL, including reference lists of identified studies. A total of 21 patient complexity management tools were found. Twenty-five studies examined the correlation between patient complexity and health-related patient outcomes, two examined healthcare costs, and one assessed impacts on healthcare providers. No studies have considered sharing information or action plans with multidisciplinary teams while measuring outcomes for complex patients. Of the tools, eleven used face-to-face interviews, seven extracted data from medical records, and three used self-assessments. The evidence of correlations between patient complexity and outcomes was insufficient for clinical implementation. Self-assessment tools might be convenient for conducting further studies. A multidisciplinary approach is essential to develop effective intervention protocols. Further research is required to determine these correlations in primary care settings.
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Affiliation(s)
- Hiromitsu Kaneko
- Faculty of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | | | - Sachiko Yamamoto-Kataoka
- Department of Health Informatics, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-cho 89, Kyoto 606-8226, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Shogoin Kawara-cho 54, Kyoto 606-8507, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Kyoto 606-8501, Japan
| | - Takuya Aoki
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Shogoin Kawara-cho 54, Kyoto 606-8507, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kokoro Shirai
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Hiroyasu Iso
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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Busnel C, Vallet F, Ashikali EM, Ludwig C. Assessing multidimensional complexity in home care: congruencies and discrepancies between patients and nurses. BMC Nurs 2022; 21:166. [PMID: 35751082 DOI: 10.1186/s12912-022-00942-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Person-centered care allows for the inclusion of the totality of a person’s needs and preferences, beyond just the clinical or medical aspect. This approach requires the development of tools to allow for the integration of the patient in his/her healthcare. Based on a 30-item tool developed for nurses to evaluate the complexity of home care situations (COMID), this study proposed a version for the patients (i.e. COMID-P). Both instruments were used, independently by nurses and patients, to rate the complexity of individual situations, in order to compare ratings. Methods The COMID-P and the COMID were completed during the fraXity study at the patients’ homes, independently by patients (aged 65 and over) and nurses. Item-level and scale-level analyses were performed using, Kappa and McNemar tests, and intra-class correlation (ICC). Results A total of 159 pairs of COMID and COMID-P ratings were retained for analyses. Results demonstrated a high degree of patient/nurse agreement for 12/30 items, a moderate agreement for 10/30 items, and a low degree of agreement for 7/30 items. The intra-class correlation between the COMID-P and the COMID was high (ICC= .826, 95%CI [.761-.873]). Conclusions The results demonstrate that patients and nurses can assess complexity using tools that have comparable structural properties. They also reveal congruencies and discrepancies in scoring the components of complexity, highlighting the need of reaching consensus in designing care plans. Further work is needed to demonstrate the benefits of joint assessment in developing care plans that truly meet patients’ needs. Trial registration The fraXity study was registered in ClinicalTrials.gov, NCT03883425, on March 20, 2019.
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de Oliveira CA, Weber B, dos Santos JLF, Zucoloto ML, de Camargo LL, Zanetti ACG, Rzewuska M, de Azevedo-Marques JM. Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool. PLoS One 2022; 17:e0263702. [PMID: 35180262 PMCID: PMC8856552 DOI: 10.1371/journal.pone.0263702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED’s validity and feasibility to assess health complexity in an adult PHC population. Method The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as “complex”. Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study—Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. Results 42 participants (18.3%) were classified as “complex”. A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (β = 2.12, t = 2.10, p < 0.05), any other health care services (β = 3.05, t = 3.97, p < 0.01), and any medication (β = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. Conclusion INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.
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Affiliation(s)
- Camila Almeida de Oliveira
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Bernardete Weber
- Registered Nurse, Hospital do Coração (HCor), São Paulo City, Brazil
| | | | - Miriane Lucindo Zucoloto
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lisa Laredo de Camargo
- Postgraduate Program in Psychiatric Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, São Paulo, Brazil
| | - Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Aberdeen Centre for Health Data Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Leckwyck LV, Gallay E, Bourquin C, Stiefel F, Cohidon C, Senn N. [Bio-Psycho-Social Needs Assessment in Family Medicine: Acceptability of the Intermed Self-Assessment]. Praxis (Bern 1994) 2022; 111:135-140. [PMID: 35232262 DOI: 10.1024/1661-8157/a003818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bio-Psycho-Social Needs Assessment in Family Medicine: Acceptability of the Intermed Self-Assessment Abstract. In view of the increasing number of patients with somato-psychic comorbidities, a tool for identifying complex patients such as the INTERMED self-assessment (IMSA) would prove useful in family medicine. An observational study was conducted in a practice with seven general practitioners to evaluate the acceptability of patients to fill in this questionnaire in the waiting room. The IMSA was quickly completed and well accepted by patients, who found the questions easy to understand and relevant to their health. The waiting room environment didn't seem to hinder the process. The majority of participants deemed useful that their doctor received the data from the questionnaire. The IMSA could be implemented in the practice to detect certain psycho-social fragilities at an early stage.
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Affiliation(s)
| | - Emilie Gallay
- Département de médecine de famille, Unisanté, Lausanne
| | - Céline Bourquin
- Service de psychiatrie de liaison, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne
| | - Friedrich Stiefel
- Service de psychiatrie de liaison, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne
| | | | - Nicolas Senn
- Département de médecine de famille, Unisanté, Lausanne
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Nicolaus S, Crelier B, Donzé JD, Aubert CE. Definition of patient complexity in adults: A narrative review. Journal of Multimorbidity and Comorbidity 2022; 12:26335565221081288. [PMID: 35586038 PMCID: PMC9106317 DOI: 10.1177/26335565221081288] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
Abstract
Background Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years. Methods We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model. Results Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decision-making, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles. Conclusion A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated non-medical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship.
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Affiliation(s)
- Stefanie Nicolaus
- Department of General Internal Medicine, Biel Hospital, Biel, Switzerland
| | - Baptiste Crelier
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
| | - Jacques D Donzé
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Division of General Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Rietkerk W, de Jonge-de Haan J, Slaets JPJ, Zuidema SU, Gerritsen DL. Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation. J Aging Health 2021; 33:482-492. [PMID: 33625262 PMCID: PMC8236665 DOI: 10.1177/0898264321993321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults.
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Affiliation(s)
- Wanda Rietkerk
- Department of General Practice and Elderly Care Medicine, 3647University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Joris P J Slaets
- Faculty of Medical Sciences, 3647University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.,443696Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, 3647University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Debby L Gerritsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Bakker MH, Vissink A, Spoorenberg SLW, Wynia K, Visser A. Self-reported oral health problems and the ability to organize dental care of community-dwelling elderly aged ≥75 years. BMC Oral Health 2020; 20:185. [PMID: 32615975 PMCID: PMC7331152 DOI: 10.1186/s12903-020-01175-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/25/2020] [Indexed: 12/21/2022] Open
Abstract
Background It is unclear how many community-dwelling elderly (≥75 years) experience oral health problems (e.g. pain, dry mouth, chewing problems) and how they manage their dental care needs. This study aimed to assess self-reported oral health problems in elderly who are frail or have complex care needs, and their ability to organize dental care when reporting oral pain. Methods Three thousand five hundred thirty-three community-dwelling elderly participating in the “Embrace” project were asked to complete questionnaires regarding oral status and oral health problems. Frailty was assessed with the Groningen Frailty Indicator (GFI). Intermed for Elderly Self-Assessment (IM-E-SA) was used to determine complexity of care needs. Next, elderly who reported oral pain were interviewed about their oral pain complaints, their need for dental care, and their ability to organize and receive dental care. For statistical analyses Chi2-tests and the one-way ANOVA were used. Results One thousand six hundred twenty-two elderly (45.9%) completed the questionnaires. Dry mouth (11.7%) and oral pain (6.2%) were most frequently reported. Among the elderly reporting oral pain, most were registered at a local dentist and could go there when needed (84.3%). Robust elderly visited the dentist independently (87%), frail (55.6%) and complex (26.9%) elderly more often required assistance from caregivers. Conclusions Dry mouth and oral pain are most reported oral health problems among community-dwelling elderly. Elderly with complex care needs report most oral health problems. In case an elderly seeks dental treatment to alleviate an oral pain complaint, most elderly in this study were able to organize dental care and transport to the dentist. Frail and complex elderly often need assistance from caregivers to visit the dentist. Therefore caretakers should keep in mind that when frailty progresses, visiting a dentist may become more and more difficult and the risk for poor oral health increases.
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Affiliation(s)
- M H Bakker
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands.
| | - A Vissink
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands
| | - S L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Visser
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, NL-9700, RB, Groningen, The Netherlands.,Department of Geriatric Dentistry, Dental School, Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Vallet F, Busnel C, Ludwig C. [Analysis of the reliability of a multidimensional complexity scale instrument (COMID) for home care nurses]. Rech Soins Infirm 2020; 138:53-64. [PMID: 31959242 DOI: 10.3917/rsi.138.0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction : The increasingly frequent mention of complexity by different health care actors challenges the measurement of this construct. The COMID, a tool that helps home nurses to identify complex situations, provides a multidimensional and operational definition of complexity.Context : While an acceptability study showed that nurses took a keen interest in the COMID, its psychometric properties have not yet been examined.Objective : This article reports on two studies testing the reliability of the scale.Method : Study 1 focuses on 5,401 COMIDs completed by home care nurses in their usual practice. The internal consistency was estimated using Cronbach's alpha. Study 2 focuses on 38 COMIDs, completed by home care nurses (rater group 1) and specialized nurses (rater group 2). Inter-rater agreement was examined using an intraclass correlation coefficient (ICC).Results : The COMID has an acceptable internal consistency α = 0.797 and an excellent inter-rater agreement ICC = 0.839.Discussion : The metrological properties of the COMID will need to be complemented by an analysis of its validity. Conclusion : The COMID has good measurement accuracy and therefore has good potential for identifying complexity in nursing practice.
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Silva HSD, Gutierrez BAO. Care complexity in hospitalized elderly according to cognitive performance. Rev Bras Enferm 2019; 72:134-139. [PMID: 31826202 DOI: 10.1590/0034-7167-2018-0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/21/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to investigate possible differences in care complexity, functional performance and biopsychosocial and health system aspects among hospitalized elderly with or without cognitive decline. METHOD quantitative, cross-sectional and analytical study in which was used the INTERMED method and cognitive and functional screening scales. We investigated 384 elderly patients admitted to a medical and surgical clinic of a University Hospital located in São Paulo/SP. RESULTS cognitive decline was present in 40.1% of the sample, most of them were longer-lived elderly individuals with less schooling and income, more dependent in activities of daily living and had greater vulnerability in different domains of INTERMED. After adjustments, the elderly with cognitive decline presented greater vulnerability in the psychological domain. CONCLUSION the relationship between cognitive decline and psychological vulnerability highlights the need to adopt long-term care based on involvement of the family, health team and different services, thereby maximizing the quality of care.
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Rietkerk W, Gerritsen DL, Kollen BJ, Hofman CS, Wynia K, Slaets JPJ, Zuidema SU. Effects Of Increasing The Involvement Of Community-Dwelling Frail Older Adults In A Proactive Assessment Service: A Pragmatic Trial. Clin Interv Aging 2019; 14:1985-1995. [PMID: 31814713 PMCID: PMC6858288 DOI: 10.2147/cia.s206100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Older adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult's well-being. METHODS We studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a "goal card" was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants. RESULTS In total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, -0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card. CONCLUSION Efforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.
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Affiliation(s)
- W Rietkerk
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - DL Gerritsen
- Department of Primary and Community Care and Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - BJ Kollen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - CS Hofman
- Department of Innovation and Research, Vilans, Centre of Expertise on Long-Term Care, Utrecht, the Netherlands
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - JPJ Slaets
- Faculty of Medical Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Leyden Academy On Vitality And Ageing, Leiden, the Netherlands
| | - SU Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Rietkerk W, Uittenbroek RJ, Gerritsen DL, Slaets JPJ, Zuidema SU, Wynia K. Goal planning in person-centred care supports older adults receiving case management to attain their health-related goals. Disabil Rehabil 2019; 43:1682-1691. [PMID: 31589075 DOI: 10.1080/09638288.2019.1672813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Care for older adults should preferably be provided in a person-centred way that includes goal planning. The aim of the present cohort study is to gain an insight into the results of goal planning, in a person-centred care setting for community-living older adults. MATERIALS AND METHODS Within Embrace, a person-centred and integrated care service, older adults set goals with the aim to improve health-related problems. For every goal, they rated severity scores ranging from 0 (no problem) to 10 (extremely severe): a baseline score, a target score and, within one year, an end score to evaluate these goals. The differences between baseline and end scores (goal progress) and target and end scores (goal attainment), and the percentage of goals attained were calculated and compared between health-related domains (i.e., mental health, physical health, mobility, and support). RESULTS Among 233 older adults, 836 goal plans were formulated of which 74% (95% Confidence Interval: 71-77) were attained. Goals related to physical health were the most likely to be attained and goals for mobility and pain the least likely. CONCLUSIONS Older adults are able to attain health-related goals through collaborative goal planning. We recommend future integrated care programmes for older adults to incorporate goal-planning methods to achieve person-centred care.IMPLICATIONS FOR REHABILITATIONOlder adults experiencing frailty or complex care needs and receiving individual support within an integrated care setting are able to formulate and attain goals using goal planning with severity scores.Goal plans of community-living older adults mostly aim at improving health-related problems concerning physical health, mobility, or support.Goals related to physical health are the most likely to be attained, while goals for mobility and pain are the least likely to be attained.
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Affiliation(s)
- Wanda Rietkerk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ronald J Uittenbroek
- Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care and Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Joris P J Slaets
- Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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14
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Bakker MH, Vissink A, Meijer HJA, Raghoebar GM, Visser A. Mandibular implant-supported overdentures in (frail) elderly: A prospective study with 20-year follow-up. Clin Implant Dent Relat Res 2019; 21:586-592. [PMID: 30993810 PMCID: PMC6767521 DOI: 10.1111/cid.12772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 01/09/2023]
Abstract
Purpose To prospectively assess long‐term (20 year) clinical, radiographic, and patient‐reported outcomes of an elderly population provided with mandibular implant‐supported overdentures. Materials and Methods A total of 53 elderly (aged ≥60 years at the time of treatment) were provided with two endosseous implants supporting a mandibular overdenture and a conventional maxillary denture. Outcome parameters—including implant loss, plaque index, gingival index, bleeding index, presence of calculus, probing depth, and satisfaction with implant‐supported overdenture—were scored 1, 5, 10, and 20 years after prosthetic treatment. Radiographic analysis was performed to assess peri‐implant bone changes. At the 20‐year evaluation, frailty (Groningen Frailty Index) and quality of life (EuroQol 5D) were additionally assessed. Results A total of 15 patients completed the 20‐year follow‐up. The 20‐year implant survival rate was 92.5%. Plaque index, bleeding index, and probing depth increased slightly over time, while gingival index and presence of calculus remained unchanged. Radiographic analysis revealed minor marginal bone loss during the first 10 years and no further loss thereafter. Participants were very satisfied with their prosthesis and reported a good quality of life. At the 20‐year evaluation, 64.3% of the patients were classified as frail. Conclusions The long‐term survival of implants supporting a mandibular overdenture is high. Although most elderly in the study became frail over time, peri‐implant health and marginal bone level remained at a satisfactory level.
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Affiliation(s)
- Mieke H Bakker
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Implant Dentistry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anita Visser
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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15
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Spoorenberg SL, Reijneveld SA, Uittenbroek RJ, Kremer HP, Wynia K. Health-Related Problems and Changes After 1 Year as Assessed With the Geriatric ICF Core Set (GeriatrICS) in Community-Living Older Adults Who Are Frail Receiving Person-Centered and Integrated Care From Embrace. Arch Phys Med Rehabil 2019; 100:2334-2345. [PMID: 30986412 DOI: 10.1016/j.apmr.2019.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/31/2018] [Accepted: 02/13/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the prevalence, severity, and change in health-related problems in a sample of older adults who received individual care and support from Embrace, for the whole sample, per subgroup based on complexity of care needs and frailty, and for those who had at baseline a health-related problem. DESIGN A pretest-posttest study with assessments at baseline and after 12 months. SETTING Community. PARTICIPANTS Older adults aged 75 years and older (N=136) who are frail (n=56) or who have complex care needs (n=80). INTERVENTION Participants received care and support by Embrace, a person-centered and integrated care service for community-living older adults supporting them to age in place. A multidisciplinary team provided care and support, with intensity depending on the older adults' risk profile. MAIN OUTCOME MEASURE Health-related problems as perceived by older adults and measured with the Geriatric International Classification of Functioning, Disability and Health Core Set. RESULTS Health-related problems were related to 6 coherent clusters: (1) Mental Functions; (2) Physical Health; (3) Mobility; (4) Personal Care; (5) Nutrition; and (6) Support. The most prevalent and most severe problems at baseline were related to Mental Functions and Mobility. Changes in the prevalence of problems after 12 months varied. Severity scores decreased or remained stable, except for Mobility items which showed a varying changing pattern in participants with complex care needs. Prevalence and severity of problems for those with a problem at baseline decreased after 12 months. Frail participants with a problem had higher baseline severity scores than those with complex care needs experiencing a problem, but differences in changes between individuals who are frail and those with complex care needs were small. CONCLUSIONS The results are encouraging and may indicate that individual, person-centered and integrated care and support from Embrace offers a route to counteracting the decline in physical, cognitive and social functioning associated with aging.
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Affiliation(s)
- Sophie L Spoorenberg
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen
| | - Sijmen A Reijneveld
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen
| | - Ronald J Uittenbroek
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen
| | - Hubertus P Kremer
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Klaske Wynia
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen; University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands.
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16
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Bakker MH, Vissink A, Spoorenberg SLW, Jager-Wittenaar H, Wynia K, Visser A. Are Edentulousness, Oral Health Problems and Poor Health-Related Quality of Life Associated with Malnutrition in Community-Dwelling Elderly (Aged 75 Years and Over)? A Cross-Sectional Study. Nutrients 2018; 10:nu10121965. [PMID: 30545100 PMCID: PMC6315642 DOI: 10.3390/nu10121965] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 12/12/2022] Open
Abstract
As the population ages, the risk of becoming malnourished increases. Research has shown that poor oral health can be a risk factor for malnutrition in institutionalized elderly. However, it remains unclear whether oral health problems, edentulousness and health-related quality of life also pose a risk for malnutrition in community-dwelling older adults. In this cross-sectional observational study, 1325 community-living elderly (≥75 years) were asked to complete questionnaires regarding nutritional status, oral status (edentulous, remaining teeth, or implant-supported overdentures), oral health problems, health-related quality of life (HRQoL), frailty, activities of daily living (ADL) and complexity of care needs. Univariate and multivariate logistic regression analyses were performed with nutritional status as dependent variable. Of the respondents, 51% (n = 521) were edentulous, 38.8% (n = 397) had remaining teeth and 10.2% (n = 104) had an implant-supported overdenture. Elderly with complex care needs were malnourished most frequently, followed by frail and robust elderly (10%, 4.5% and 2.9%, respectively). Malnourished elderly reported more frequent problems with chewing and speech when compared with well-nourished elderly (univariate analysis). However, multivariate analysis did not show an association between malnutrition and oral health problems and edentulousness, although HRQoL was associated with malnutrition (odds ratio (OR) 0.972, confidence interval (CI) 0.951–0.955). Based on the results of this cross-sectional study, it can be concluded that poor HRQoL is significantly associated with malnutrition; however, edentulousness and oral health problems are not.
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Affiliation(s)
- Mieke H Bakker
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
| | - Sophie L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9714 CA Groningen, The Netherlands.
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
| | - Anita Visser
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
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17
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Uittenbroek RJ, van der Mei SF, Slotman K, Reijneveld SA, Wynia K. Experiences of case managers in providing person-centered and integrated care based on the Chronic Care Model: A qualitative study on embrace. PLoS One 2018; 13:e0207109. [PMID: 30439971 PMCID: PMC6237343 DOI: 10.1371/journal.pone.0207109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 10/25/2018] [Indexed: 11/23/2022] Open
Abstract
Background Due to the rise in the number of older adults within the population, healthcare demands are changing drastically, all while healthcare expenditure continues to grow. Person-centered and integrated-care models are used to support the redesigning the provision of care and support. Little is known, however, about how redesigning healthcare delivery affects the professionals involved. Objectives To explore how district nurses and social workers experience their new professional roles as case managers within Embrace, a person-centered and integrated-care service for community-living older adults. Methods We performed a qualitative study consisting of in-depth interviews with case managers (district nurses, n = 6; social workers, n = 5), using a topic-based interview guide. Audiotaped interviews were transcribed verbatim and analyzed using qualitative content analysis. Results The experiences of the case managers involved four major themes: 1) the changing relationship with older adults, 2) establishing the case-manager role, 3) the case manager’s toolkit, and 4) the benefits of case management. Within these four themes, subthemes addressed the shift to a person-centered approach, building a relationship of trust, the process of case management, knowledge and experience, competencies of and requirements for case managers, and the differences in professional background. Discussion We found that this major change in role was experienced as a learning process, one that provided opportunities for personal and professional growth. Case managers felt that they were able to make a difference, and found their new roles satisfying and challenging, although stressful at times. Ongoing training and support were found to be a prerequisite in helping to shift the focus towards person-centered and integrated care.
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Affiliation(s)
- Ronald J. Uittenbroek
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | - Sijrike F. van der Mei
- Department of Health Sciences, Applied Health Research University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Karin Slotman
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sijmen A. Reijneveld
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Neurology University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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18
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Wittevrongel V, Reneman MF. Capturing case complexity: is clinician selected dose of vocational rehabilitation related to questionnaire results? Disabil Rehabil 2018; 42:692-697. [PMID: 30372651 DOI: 10.1080/09638288.2018.1506514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: To establish an optimum dosage interdisciplinary vocational rehabilitation, it is important to be able to reliably and validly assess case complexity. Assessment of case complexity is currently clinician based because no validated means to assess case complexity is presently available. Indices assumed to associate with case complexity can contribute to the choice of dosage. The objective of this study was to explore the extent in which results of questionnaires were associated with the choice of treatment dosage in vocational rehabilitation.Methods: Design: cross-sectional study of observational data. The study population consisted of workers on part-time or full-time sick leave due to chronic multifactorial problems. Thousand eighty-nine patients who were referred to a privately owned organization with outpatient vocational rehabilitation centers in the Netherlands between July 2016 and March 2017 were allocated to one of the three programs based on case complexity as determined by clinicians based on clinical interview and questionnaires.Results: Questionnaires accounted for 13% of the variance in the total group, 13% in patients with chronic musculoskeletal pain (n = 662) and 29% in patients with chronic fatigue (n = 235).Conclusion: The results of the questionnaires contribute little in the assessment of case complexity and dose recommendation.Implications for RehabilitationAssessment of case complexity of patients with chronic multifactorial complaints and disability is complex.The results of this study suggest that case complexity and choice of treatment dose is slightly explained by questionnaire results. It is largely determined on heuristics developed by knowledge and experience of clinicians.No reliable and validated means to assess case complexity is presently available in the field of rehabilitation and optimum treatment dose cannot be determined transparently.Routinely collected clinical data of baseline characteristics, process measures and results are a valuable source that can be used to answer research questions.
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Affiliation(s)
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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Marcus-Varwijk AE, Peters LL, Visscher TLS, Smits CHM, Ranchor AV, Slaets JPJ. Impact of a Nurse-Led Health Promotion Intervention in an Aging Population: Results From a Quasi-Experimental Study on the "Community Health Consultation Offices for Seniors". J Aging Health 2018; 32:83-94. [PMID: 30326768 PMCID: PMC7322977 DOI: 10.1177/0898264318804946] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: The study evaluated the nurse-led intervention "Community Health Consultation Offices for Seniors (CHCO)" on health-related and care needs-related outcomes in community-dwelling older people (⩾60 years). Method: With a quasi-experimental design, the CHCO intervention was evaluated on health-related and care needs-related outcomes after 1-year follow-up. Older people who received the intervention were frail, overweight, or were smoking. The comparison group received care as usual. In both groups, similar data were collected on health status, falls and fractures, and care needs. In the intervention group, additional data were collected on biometric measures and health-related behavior. Results: The intervention group and the care-as-usual group included 403 seniors and 984 seniors, respectively. Health-related outcomes, behaviors, and biometric measures, remained stable. After 1 year, care needs increased for both groups, but at a lower rate for the care-as-usual group. Discussion: The CHCO intervention showed no significant improvement on health-related outcomes or stability in care needs-related outcomes.
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Affiliation(s)
- Anne Esther Marcus-Varwijk
- Windesheim University of Applied Sciences, Research Group Innovating with Older Adults, Zwolle, The Netherlands.,University of Groningen, University Medical Center Groningen, Department Internal Medicine, the Netherlands
| | - Lilian L Peters
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, The Netherlands
| | - Tommy L S Visscher
- Windesheim University of Applied Sciences, Research Group Healthy Cities, Zwolle, The Netherlands
| | - Carolien H M Smits
- Windesheim University of Applied Sciences, Research Group Innovating with Older Adults, Zwolle, The Netherlands
| | - Adelita V Ranchor
- University of Groningen, University Medical Center Groningen, Health Psychology Section, The Netherlands
| | - Joris P J Slaets
- University of Groningen, University Medical Center Groningen, Department Internal Medicine, the Netherlands.,Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
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20
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Looman WM, Fabbricotti IN, Blom JW, Jansen APD, Lutomski JE, Metzelthin SF, Huijsman R. The frail older person does not exist: development of frailty profiles with latent class analysis. BMC Geriatr 2018; 18:84. [PMID: 29618334 PMCID: PMC5885355 DOI: 10.1186/s12877-018-0776-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background A fundamental issue in elderly care is targeting those older people at risk and in need of care interventions. Frailty is widely used to capture variations in health risks but there is no general consensus on the conceptualization of frailty. Indeed, there is considerable heterogeneity in the group of older people characterized as frail. This research identifies frailty profiles based on the physical, psychological, social and cognitive domains of functioning and the severity of the problems within these domains. Methods This research was a secondary data-analysis of older persons derived from The Older Person and Informal Caregiver Minimum Dataset. Selected respondents were 60 years and older (n = 43,704; 59.6% female). The following variables were included: self-reported health, cognitive functioning, social functioning, mental health, morbidity status, and functional limitations. Using latent class analysis, the population was divided in subpopulations that were subsequently discussed in a focus group with older people for further validation. Results We distinguished six frailty profiles: relatively healthy; mild physically frail; psychologically frail; severe physically frail; medically frail and multi-frail. The relatively healthy had limited problems across all domains. In three profiles older people mostly had singular problems in either the physical or psychological domain and the severity of the problems differed. Two remaining profiles were multidimensional with a combination of problems that extended to the social and cognitive domains. Conclusions Our research provides an empirical base for meaningful frailty profiles. The profiles showed specific patterns underlying the problems in different domains of functioning. The heterogeneous population of frail older people has differing needs and faces different health issues that should be considered to tailor care interventions. Evaluation research of these interventions should acknowledge the heterogeneity of frailty by profiling. Electronic supplementary material The online version of this article (10.1186/s12877-018-0776-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- W M Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - I N Fabbricotti
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - J W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - A P D Jansen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research Institute, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - J E Lutomski
- Radboud Biobank, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - S F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - R Huijsman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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21
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Uittenbroek RJ, van Asselt ADI, Spoorenberg SLW, Kremer HPH, Wynia K, Reijneveld SA. Integrated and Person-Centered Care for Community-Living Older Adults: A Cost-Effectiveness Study. Health Serv Res 2018; 53:3471-3494. [PMID: 29573398 DOI: 10.1111/1475-6773.12853] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of Embrace, an integrated primary care service for older adults. DATA SOURCES Care and support claims from health care insurers, long-term care administration, and municipalities for enrolled older adults between 2011 and 2013. STUDY DESIGN A total of 1,456 older adults, listed with 15 general practitioners practices in the Netherlands, were stratified into risk profiles ("Robust," "Frail," and "Complex care needs") and randomized to Embrace or care-as-usual groups. Incremental costs were calculated per quality-adjusted life year, per day able to age in place, and per percentage point risk profile improvement. PRINCIPAL FINDINGS Total average costs were higher for Embrace compared to care-as-usual. Differences in health-associated outcomes were small and not statistically significant. Probabilities that Embrace is cost-effective were below 80 percent, except for "risk profile improvements" within risk profile "Complex care needs." Complete case analysis resulted in smaller differences in total average costs across conditions and differences in health-associated outcomes remained small. CONCLUSIONS According to current standards, Embrace is not considered cost effective after 12 months. However, it could be considered worthwhile in terms of "risk profile improvements" for older adults with "Complex care needs," if society is willing to invest substantially.
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Affiliation(s)
- Ronald J Uittenbroek
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antoinette D I van Asselt
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Sophie L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hubertus P H Kremer
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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22
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Spoorenberg SLW, Wynia K, Uittenbroek RJ, Kremer HPH, Reijneveld SA. Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults: A randomised controlled trial on Embrace. PLoS One 2018; 13:e0190751. [PMID: 29351295 PMCID: PMC5774687 DOI: 10.1371/journal.pone.0190751] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/26/2017] [Indexed: 02/01/2023] Open
Abstract
Objective To evaluate the effects of the population-based, person-centred and integrated care service ‘Embrace’ at twelve months on three domains comprising health, wellbeing and self-management among community-living older people. Methods Embrace supports older adults to age in place. A multidisciplinary team provides care and support, with intensity depending on the older adults’ risk profile. A randomised controlled trial was conducted in fifteen general practices in the Netherlands. Older adults (≥75 years) were included and stratified into three risk profiles: Robust, Frail and Complex care needs, and randomised to Embrace or care as usual (CAU). Outcomes were recorded in three domains. The EuroQol-5D-3L and visual analogue scale, INTERMED for the Elderly Self-Assessment, Groningen Frailty Indicator and Katz-15 were used for the domain ‘Health.’ The Groningen Well-being Indicator and two quality of life questions measured ‘Wellbeing.’ The Self-Management Ability Scale and Partners in Health scale for older adults (PIH-OA) were used for ‘Self-management.’ Primary and secondary outcome measurements differed per risk profile. Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses, for the whole sample and per risk profile. Results 1456 eligible older adults participated (49%) and were randomized to Embrace (n(T0) = 747, n(T1) = 570, mean age 80.6 years (SD 4.5), 54.2% female) and CAU (n(T0) = 709, n(T1) = 561, mean age 80.8 years (SD 4.7), 55.6% female). Embrace participants showed a greater–but clinically irrelevant–improvement in self-management (PIH-OA Knowledge subscale effect size [ES] = 0.14), and a greater–but clinically relevant–deterioration in health (ADL ES = 0.10; physical ADL ES = 0.13) compared to CAU. No differences in change in wellbeing were observed. This picture was also found in the risk profiles. Complete case analyses showed comparable results. Conclusions This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health, wellbeing and self-management in community-living older adults.
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Affiliation(s)
- Sophie L. W. Spoorenberg
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Groningen, The Netherlands
- * E-mail:
| | - Klaske Wynia
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, Groningen, The Netherlands
| | - Ronald J. Uittenbroek
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Groningen, The Netherlands
| | - Hubertus P. H. Kremer
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, Groningen, The Netherlands
| | - Sijmen A. Reijneveld
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Groningen, The Netherlands
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Marcoux V, Chouinard MC, Diadiou F, Dufour I, Hudon C. Screening tools to identify patients with complex health needs at risk of high use of health care services: A scoping review. PLoS One 2017; 12:e0188663. [PMID: 29190658 DOI: 10.1371/journal.pone.0188663] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/10/2017] [Indexed: 12/02/2022] Open
Abstract
Background Many people with chronic conditions have complex health needs often due to multiple chronic conditions, psychiatric comorbidities, psychosocial issues, or a combination of these factors. They are at high risk of frequent use of healthcare services. To offer these patients interventions adapted to their needs, it is crucial to be able to identify them early. Objective The aim of this study was to find all existing screening tools that identify patients with complex health needs at risk of frequent use of healthcare services, and to highlight their principal characteristics. Our purpose was to find a short, valid screening tool to identify adult patients of all ages. Methods A scoping review was performed on articles published between 1985 and July 2016, retrieved through a comprehensive search of the Scopus and CINAHL databases, following the methodological framework developed by Arksey and O’Malley (2005), and completed by Levac et al. (2010). Results Of the 3,818 articles identified, 30 were included, presenting 14 different screening tools. Seven tools were self-reported. Five targeted adult patients, and nine geriatric patients. Two tools were designed for specific populations. Four can be completed in 15 minutes or less. Most screening tools target elderly persons. The INTERMED self-assessment (IM-SA) targets adults of all ages and can be completed in less than 15 minutes. Conclusion Future research could evaluate its usefulness as a screening tool for identifying patients with complex needs at risk of becoming high users of healthcare services.
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Uittenbroek RJ, Kremer HPH, Spoorenberg SLW, Reijneveld SA, Wynia K. Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace. J Gen Intern Med 2017; 32:516-523. [PMID: 27271728 PMCID: PMC5400746 DOI: 10.1007/s11606-016-3742-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/08/2016] [Accepted: 05/02/2016] [Indexed: 11/13/2022]
Abstract
BACKGROUND All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care. OBJECTIVE To examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care. DESIGN Stratified randomized controlled trial. PARTICIPANTS Integrated care and support according to the "Embrace" model was provided by 15 general practitioners in the Netherlands. Based on self-reported levels of case complexity and frailty, a total of 1456 community-living older adults were stratified into non-disease-specific risk profiles ("Robust," "Frail," and "Complex care needs"), and randomized to Embrace or control groups. INTERVENTION Embrace provides integrated, person-centered primary care and support to all older adults living in the community, with intensity of care dependent on risk profile. MEASUREMENTS Primary outcome was quality of care as reported by older adults on the Patient Assessment of Integrated Elderly Care (PAIEC). Effects were assessed using mixed model techniques for the total sample and per risk profile. Professionals' perceived level of implementation of integrated care was evaluated within the Embrace condition using the Assessment of Integrated Elderly Care. KEY RESULTS Older adults in the Embrace group reported a higher level of perceived quality of care than those in the control group (B = 0.33, 95 % CI = 0.15-0.51, ES d = 0.19). The advantages of Embrace were most evident in the "Frail" and "Complex care needs" risk profiles. We found no significant advantages for the "Robust" risk profile. Participating professionals reported a significant increase in the perceived level of implementation of integrated care (ES r = 0.71). CONCLUSIONS This study shows that providing a population-based integrated care service to community-living older adults improved the quality of care as perceived by older adults and participating professionals.
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Affiliation(s)
- Ronald J Uittenbroek
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P.O. BOX 196, 9700 AD, Groningen, The Netherlands.
| | - Hubertus P H Kremer
- Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. BOX 30001, 9700 RB, Groningen, The Netherlands
| | - Sophie L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P.O. BOX 196, 9700 AD, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P.O. BOX 196, 9700 AD, Groningen, The Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P.O. BOX 196, 9700 AD, Groningen, The Netherlands.,Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. BOX 30001, 9700 RB, Groningen, The Netherlands
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van Reedt Dortland AKB, Peters LL, Boenink AD, Smit JH, Slaets JPJ, Hoogendoorn AW, Joos A, Latour CHM, Stiefel F, Burrus C, Guitteny-Collas M, Ferrari S. Assessment of Biopsychosocial Complexity and Health Care Needs: Measurement Properties of the INTERMED Self-Assessment Version. Psychosom Med 2017; 79:485-92. [PMID: 28033198 DOI: 10.1097/PSY.0000000000000446] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The INTERMED Self-Assessment questionnaire (IMSA) was developed as an alternative to the observer-rated INTERMED (IM) to assess biopsychosocial complexity and health care needs. We studied feasibility, reliability, and validity of the IMSA within a large and heterogeneous international sample of adult hospital inpatients and outpatients as well as its predictive value for health care use (HCU) and quality of life (QoL). METHODS A total of 850 participants aged 17 to 90 years from five countries completed the IMSA and were evaluated with the IM. The following measurement properties were determined: feasibility by percentages of missing values; reliability by Cronbach α; interrater agreement by intraclass correlation coefficients; convergent validity of IMSA scores with mental health (Short Form 36 emotional well-being subscale and Hospital Anxiety and Depression Scale), medical health (Cumulative Illness Rating Scale) and QoL (Euroqol-5D) by Spearman rank correlations; and predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models. RESULTS Feasibility, face validity, and reliability (Cronbach α = 0.80) were satisfactory. Intraclass correlation coefficient between IMSA and IM total scores was .78 (95% CI = .75-.81). Correlations of the IMSA with the Short Form 36, Hospital Anxiety and Depression Scale, Cumulative Illness Rating Scale, and Euroqol-5D (convergent validity) were -.65, .15, .28, and -.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency department visits, hospitalization, outpatient visits, and diagnostic examinations) after 3- and 6-month follow-up. Results were comparable between hospital sites, inpatients and outpatients, as well as age groups. CONCLUSIONS The IMSA is a generic and time-efficient method to assess biopsychosocial complexity and to provide guidance for multidisciplinary care trajectories in adult patients, with good reliability and validity across different cultures.
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Hoeksema AR, Spoorenberg SLW, Peters LL, Meijer HJA, Raghoebar GM, Vissink A, Wynia K, Visser A. Elderly with remaining teeth report less frailty and better quality of life than edentulous elderly: a cross-sectional study. Oral Dis 2017; 23:526-536. [DOI: 10.1111/odi.12644] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/30/2016] [Accepted: 01/16/2017] [Indexed: 01/11/2023]
Affiliation(s)
- AR Hoeksema
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - SLW Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - LL Peters
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - HJA Meijer
- Departments of Oral and Maxillofacial Surgery and Fixed and Removable Prosthodontics; Dental School; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - GM Raghoebar
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - A Visser
- Department of Oral and Maxillofacial Surgery; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
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Bleijenberg N, de Jonge A, Brand MP, O'Flynn C, Schuurmans MJ, de Wit NJ. [Implementation of a proactive integrated primary care program for frail older people: from science to evidence-based practice]. Tijdschr Gerontol Geriatr 2016; 47:234-248. [PMID: 27882453 DOI: 10.1007/s12439-016-0200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Multimorbidity, functional impairment and frailty among community-dwelling older people are causing increasing complexity in primary care. A proactive integrated primary care approach is therefore essential. Between October 2014-2015, an evidence-based proactive care program for frail older people was implemented in the region Noord-West Veluwe en Zeewolde, the Netherlands. This study evaluated the feasibility of the implementation, having a strong focus on the collaboration between the medical and social domain. METHODS Using a mixed-methods design we evaluated several process indicators. Data were obtained from electronic routine medical record data within primary care, questionnaires, and interviews with older adults. The questionnaires provided information regarding the expectations and experiences towards the program and were sent to health care professionals at baseline and six months follow-up. Stakeholders from various domains were asked to fill in the questionnaire at baseline and twelve months follow-up. Interviews were conducted to explore the experiences of older adults with the program. Regional work groups were set up in each municipality to enhance the interdisciplinary and domain transcending collaboration. RESULTS The proactive primary care program was implemented in 42 general practices who provided care to 7904 older adults aged 75 years or older. A total of 101 health care professionals and 44 stakeholders filled in the questionnaires. The need for better structure and interdisciplinary cooperation seemed widespread among the participants. The implementation resulted in a positive significant change in the demand for a better regional healthcare-framework (34% p ≤ .001) among health care professionals, and the needs for transparency regarding the possibilities for referral improved (27% , p = .009). Half of the participants reported that the regional collaboration has been improved after the implementation. Health care professionals and stakeholders gained increased attention and awareness of frail elderly in their area compared to before the implementation. Older people and their caregivers were positive about the proactive approach. The nurses reported that the screenings questionnaire was too lengthy and therefore time consuming. CONCLUSIONS The implementation of the proactive primary care approach in daily practice was feasible. A strong interdisciplinary collaboration was realized. The program was easily adapted to the local context.
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Affiliation(s)
- Nienke Bleijenberg
- Divisie Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, afdeling verplegingswetenschap, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Postbus 35500 Str. 6.131, 3508 GA, Utrecht, Nederland.
| | | | - Morris P Brand
- Geneeskundestudenten, Universiteit Utrecht, Utrecht, Nederland
| | | | - Marieke J Schuurmans
- Divisie Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, afdeling verplegingswetenschap, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Postbus 35500 Str. 6.131, 3508 GA, Utrecht, Nederland
| | - Niek J de Wit
- divisie Julius Centrum voor Gezondheitswetenschapen en Eestelijns Geneeskunde, afdeling huisartsgeneeskunde, Universitair Medisch Centrum Utrecht, Utrecht, Nederland
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Bleijenberg N, Drubbel I, Schuurmans MJ, Dam HT, Zuithoff NPA, Numans ME, de Wit NJ. Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:1779-88. [PMID: 27459236 DOI: 10.1111/jgs.14325] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine the effectiveness of a proactive primary care program on the daily functioning of older people in primary care. DESIGN Single-blind, three-arm, cluster-randomized controlled trial with 1-year follow-up. SETTING Primary care setting, 39 general practices in the Netherlands. PARTICIPANTS Community-dwelling people aged 60 and older (N = 3,092). INTERVENTIONS A frailty screening intervention using routine electronic medical record data to identify older people at risk of adverse events followed by usual care from a general practitioner; after the screening intervention, a nurse-led care program consisting of a comprehensive geriatric assessment, evidence-based care planning, care coordination, and follow-up; usual care. MEASUREMENTS Primary outcome was daily functioning measured using the Katz-15 (6 activities of daily living (ADLs), 8 instrumental activities of daily living (IADLs), one mobility item (range 0-15)); higher scores indicate greater dependence. Secondary outcomes included quality of life, primary care consultations, hospital admissions, emergency department visits, nursing home admissions, and mortality. RESULTS The participants in both intervention arms had less decline in daily functioning than those in the usual care arm at 12 months (mean Katz-15 score: screening arm, 1.87, 95% confidence interval (CI) = 1.77-1.97; screening and nurse-led care arm, 1.88, 95% CI = 1.80-1.96; control group, 2.03, 95% CI = 1.92-2.13; P = .03). No differences in quality of life were observed. CONCLUSION Participants in both intervention groups had less decline than those in the control group at 1-year follow-up. Despite the statistically significant effect, the clinical relevance is uncertain at this point because of the small differences. Greater customizing of the intervention combined with prolonged follow-up may lead to more-robust results.
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Affiliation(s)
- Nienke Bleijenberg
- Department of General Practice, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands.
| | - Irene Drubbel
- Department of General Practice, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| | - Marieke J Schuurmans
- Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| | - Hester Ten Dam
- Department of General Practice, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Department of Biostatistics, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, LUMC Leiden, the Netherlands
| | - Niek J de Wit
- Department of General Practice, Nursing Science and Sports Medicine, University Medical Center Utrecht, the Netherlands
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Bulamu NB, Kaambwa B, Ratcliffe J. A systematic review of instruments for measuring outcomes in economic evaluation within aged care. Health Qual Life Outcomes 2015; 13:179. [PMID: 26553129 PMCID: PMC4640110 DOI: 10.1186/s12955-015-0372-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/22/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector. METHODS Online databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000. RESULTS The most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care. CONCLUSION In the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.
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Affiliation(s)
- Norma B Bulamu
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
| | - Billingsley Kaambwa
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
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Lobo E, Ventura T, Navio M, Santabárbara J, Kathol R, Samaniego E, Marco C, Lobo A. Identification of components of health complexity on internal medicine units by means of the INTERMED method. Int J Clin Pract 2015; 69:1377-86. [PMID: 26271926 DOI: 10.1111/ijcp.12721] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/27/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The INTERMED was developed for the early identification of biological, psychological, social and health system factors considered interacting in health complexity. This is defined as the interference with the achievement of expected or desired health and service use outcomes when patients are exposed to standard care. OBJECTIVE The aim of this study was to test the INTERMED's ability to identify 'case' and 'care' complexity, identifying patients that would especially benefit from integrated care. METHODS Observational longitudinal study of Internal medicine in patients in two National Health System hospitals in Spain using the INTERMED (patients scoring ≥ 21 were considered to be 'complex'); the Cumulative Illness Rating Scale (CIRS), a severity of illness assessment; and standard clinical variables. RESULTS Six hundred and fifteen consecutives were included, and the prevalence of health complexity was 27.6%. The greatest differences between patients with and without health complexity were observed in the non-biological domains. Eighty-five per cent of patients with health complexity had non-biological items considered to require timely (immediately or soon) assistance or intervention compared to 30% of those without, nearly a threefold difference. Complex patients had a significantly higher number of medical diagnoses (p = 0.002) and number of psychiatric referrals (p = 0.041), but there were no differences in CIRS scores or lengths of stay. CONCLUSION The INTERMED has the potential to identify a considerable subset of complex internal medicine inpatients for which timely corrective action related to non-biological risk factors not typically uncovered during standard medical evaluations would be considered beneficial.
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Affiliation(s)
- E Lobo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - T Ventura
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
- Servicio de Psiquiatría, Hospital Clínico Universitario, Zaragoza, Spain
| | - M Navio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Servicio de Psiquiatría, Hospital Doce de Octubre, Madrid, Spain
| | - J Santabárbara
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - R Kathol
- Cartesian Solutions, Inc™, Burnsville, MN, USA
- Departments of Internal Medicine and Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - E Samaniego
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain
- Hospital Residencia Profesor Rey Ardid, Zaragoza, Spain
| | - C Marco
- Servicio de Psiquiatría, Hospital Clínico Universitario, Zaragoza, Spain
| | - A Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
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Peters LL, Burgerhof JG, Boter H, Wild B, Buskens E, Slaets JP. Predictive validity of a frailty measure (GFI) and a case complexity measure (IM-E-SA) on healthcare costs in an elderly population. J Psychosom Res 2015; 79:404-11. [PMID: 26526316 DOI: 10.1016/j.jpsychores.2015.09.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 09/03/2015] [Accepted: 09/27/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Measures of frailty (Groningen Frailty Indicator, GFI) and case complexity (INTERMED for the Elderly, IM-E-SA) may assist healthcare professionals to allocate healthcare resources. Both instruments have been evaluated with good psychometric properties. Limited evidence has been published about their predictive validity. Thus, our aim is to evaluate the predictive validity of both instruments on healthcare costs. METHODS Multivariate linear regression models were developed to estimate associations between the predictors frailty (GFI) and/or case complexity (IM-E-SA) and the healthcare costs (in € log transformed) in the following year. All models were adjusted for demographics and the presence of morbidity. RESULTS In the multivariate regression analyses the continuous scores of the GFI and IM-E-SA remained significant predictors for total healthcare costs. Adjusted βs for GFI and IM-E-SA were respectively 0.14 (95% CI 0.10-0.18) and 0.06 (95% CI 0.04-0.07). The corresponding explained variance (R(2)) for both models was 0.40. Frailty remained a significant predictor of long-term care costs (adjusted β 0.13 [95% CI 0.09-0.16]), while case complexity was a significant predictor of curative care costs (adjusted β 0.03 [95% CI 0.02-0.05]). CONCLUSIONS The GFI and IM-E-SA both accurately predict total healthcare costs in the following year.
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Spoorenberg SL, Wynia K, Fokkens AS, Slotman K, Kremer HP, Reijneveld SA. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study. PLoS One 2015; 10:e0137803. [PMID: 26489096 DOI: 10.1371/journal.pone.0137803] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/21/2015] [Indexed: 11/19/2022] Open
Abstract
Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Methods Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Results Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. Conclusion The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.
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Kaambwa B, Gill L, McCaffrey N, Lancsar E, Cameron ID, Crotty M, Gray L, Ratcliffe J. An empirical comparison of the OPQoL-Brief, EQ-5D-3 L and ASCOT in a community dwelling population of older people. Health Qual Life Outcomes 2015; 13:164. [PMID: 26420314 DOI: 10.1186/s12955-015-0357-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/18/2015] [Indexed: 11/21/2022] Open
Abstract
Background This study examined the relationships between a newly developed older person-specific non-preference-based quality of life (QoL) instrument (Older People’s Quality of Life brief questionnaire (OPQoL-brief)) and two generic preference-based instruments (the EQ-5D-3L Level (EQ-5D-3 L) and the Adult Social Care Outcomes Toolkit (ASCOT) in a community-dwelling population of Australian older people receiving aged care services. Methods We formulated hypotheses about the convergent validity between the instruments (examined by Wilcoxon-Mann Whitney, Kruskal Wallis and Spearman’s correlation tests) and levels of agreement (assessed using intra class correlation (ICC) and modified Bland-Altman plots based on normalized Z EQ-5D-3 L and ASCOT utilities and OPQoL-Brief summary scores). Results The utilities/summary scores for 87 participants (aged 65–93 years) were moderately but positively correlated. Moderate convergent validity was evident for a number of instrument dimensions with the strongest relationship (r = 0.57) between ‘enjoy life’ (OPQoL-Brief) and ‘social contact’ (ASCOT). The overall ICC was 0.54 and Bland-Altman scatter plots showed 3–6 % of normalized Z-scores were outside the 95 % limits of agreement suggesting moderate agreement between all three instruments (agreement highest between the OPQoL-Brief and the ASCOT). Conclusions Our results suggest that the OPQoL-Brief, the ASCOT and the EQ-5D_3L are suitable for measuring quality of life outcomes in community-dwelling populations of older people. Given the different constructs underpinning these instruments, we recommend that choice of instrument should be guided by the context in which the instruments are being applied. Currently, the OPQoL-Brief is not suitable for use in cost-utility analyses as it is not preference-based. Given their different perspectives, we recommend that both the ASCOT and the EQ-5D are applied simultaneously to capture broader aspects of quality of life and health status within cost-utility analyses within the aged care sector. Future research directed towards the development of a new single preference-based instrument that incorporates both health status and broader aspects of quality of life within quality adjusted life year calculations for older people would be beneficial.
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Bleijenberg N, Boeije HR, Onderwater AT, Schuurmans MJ. Frail Older Adults’ Experiences With a Proactive, Nurse-Led Primary Care Program: A Qualitative Study. J Gerontol Nurs 2015; 41:20-9; quiz 30-1. [DOI: 10.3928/00989134-20150814-03] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/07/2015] [Indexed: 11/20/2022]
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Uittenbroek RJ, Reijneveld SA, Stewart RE, Spoorenberg SLW, Kremer HPH, Wynia K. Development and psychometric evaluation of a measure to evaluate the quality of integrated care: the Patient Assessment of Integrated Elderly Care. Health Expect 2015; 19:962-72. [PMID: 26230633 PMCID: PMC5042070 DOI: 10.1111/hex.12391] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Novel population-based integrated care services are being developed to adequately serve the growing number of elderly people. Suitable, reliable and valid measurement instruments are needed to evaluate the quality of care delivered. OBJECTIVE To develop a measure to evaluate the quality of integrated care from the perspective of elderly people, the Patient Assessment of Integrated Elderly Care (PAIEC), and then to assess its psychometric properties. METHODS/DESIGN After the Patient Assessment of Chronic Illness Care was adapted to the PAIEC, a cross-sectional postal-survey study was performed among 223 elderly people who received integrated elderly care and support. We assessed the factor structure, internal consistency, known groups and divergent validity using robust nonparametric tests. RESULTS Mean age of participants was 83 years (standard deviation 4.7), and 69% was female. The original five-factor model was rejected; a good fit was found for a three-factor model, when excluding the item on patients' satisfaction with care. The PAIEC and its subscales showed good internal consistency (ordinal alphas > 0.90). Known-groups validity was supported regarding number of medications, prevalence of chronic conditions and home care received. No differences were found between groups based on sociodemographic aspects. Divergent validity was supported by low correlations (Spearman's rank correlation coefficients < 0.30) between PAIEC scales and measures of quality of life, complexity of care needs and frailty. CONCLUSION The PAIEC seems to have considerable potential as a reliable and valid measurement instrument that evaluates quality of integrated care and support from the perspective of elderly people.
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Affiliation(s)
- Ronald J Uittenbroek
- Department of Health Sciences, Community and Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sophie L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hubertus P H Kremer
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Peters LL, Boter H, Burgerhof JGM, Slaets JPJ, Buskens E. Construct validity of the Groningen Frailty Indicator established in a large sample of home-dwelling elderly persons: Evidence of stability across age and gender. Exp Gerontol 2015; 69:129-41. [PMID: 25981741 DOI: 10.1016/j.exger.2015.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 04/03/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The primary objective of the present study was to evaluate the validity of the Groningen Frailty Indicator (GFI) in a sample of Dutch elderly persons participating in LifeLines, a large population-based cohort study. Additional aims were to assess differences between frail and non-frail elderly and examine which individual characteristics were associated with frailty. METHODS By December 2012, 5712 elderly persons were enrolled in LifeLines and complied with the inclusion criteria of the present study. Mann-Whitney U or Kruskal-Wallis tests were used to assess the variability of GFI-scores among elderly subgroups that differed in demographic characteristics, morbidity, obesity, and healthcare utilization. Within subgroups Kruskal-Wallis tests were also used to examine differences in GFI-scores across age groups. Multivariate logistic regression analyses were performed to assess associations between individual characteristics and frailty. RESULTS The GFI discriminated between subgroups: statistically significantly higher GFI-median scores (interquartile range) were found in e.g. males (1 [0-2]), the oldest old (2 [1-3]), in elderly who were single (1 [0-2]), with lower socio economic status (1 [0-3]), with increasing co-morbidity (2 [1-3]), who were obese (2 [1-3]), and used more healthcare (2 [1-4]). Overall age had an independent and statistically significant association with GFI scores. Compared with the non-frail, frail elderly persons experienced statistically significantly more chronic stress and more social/psychological related problems. In the multivariate logistic regression model, psychological morbidity had the strongest association with frailty. CONCLUSION The present study supports the construct validity of the GFI and provides an insight in the characteristics of (non)frail community-dwelling elderly persons participating in LifeLines.
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Affiliation(s)
- L L Peters
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Unit Health Technology Assessment, The Netherlands.
| | - H Boter
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Section Trial Coordination Centre, The Netherlands
| | - J G M Burgerhof
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Unit Medical Statistics, The Netherlands
| | - J P J Slaets
- University of Groningen, University Medical Center Groningen, Department of Geriatric Medicine, The Netherlands
| | - E Buskens
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Unit Health Technology Assessment, The Netherlands
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Spoorenberg SLW, Reijneveld SA, Middel B, Uittenbroek RJ, Kremer HPH, Wynia K. The Geriatric ICF Core Set reflecting health-related problems in community-living older adults aged 75 years and older without dementia: development and validation. Disabil Rehabil 2015; 37:2337-43. [PMID: 25784203 DOI: 10.3109/09638288.2015.1024337] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of the present study was to develop a valid Geriatric ICF Core Set reflecting relevant health-related problems of community-living older adults without dementia. METHODS A Delphi study was performed in order to reach consensus (≥70% agreement) on second-level categories from the International Classification of Functioning, Disability and Health (ICF). The Delphi panel comprised 41 older adults, medical and non-medical experts. Content validity of the set was tested in a cross-sectional study including 267 older adults identified as frail or having complex care needs. RESULTS Consensus was reached for 30 ICF categories in the Delphi study (fourteen Body functions, ten Activities and Participation and six Environmental Factors categories). Content validity of the set was high: the prevalence of all the problems was >10%, except for d530 Toileting. The most frequently reported problems were b710 Mobility of joint functions (70%), b152 Emotional functions (65%) and b455 Exercise tolerance functions (62%). No categories had missing values. CONCLUSION The final Geriatric ICF Core Set is a comprehensive and valid set of 29 ICF categories, reflecting the most relevant health-related problems among community-living older adults without dementia. This Core Set may contribute to optimal care provision and support of the older population. Implications for Rehabilitation The Geriatric ICF Core Set may provide a practical tool for gaining an understanding of the relevant health-related problems of community-living older adults without dementia. The Geriatric ICF Core Set may be used in primary care practice as an assessment tool in order to tailor care and support to the needs of older adults. The Geriatric ICF Core Set may be suitable for use in multidisciplinary teams in integrated care settings, since it is based on a broad range of problems in functioning. Professionals should pay special attention to health problems related to mobility and emotional functioning since these are the most prevalent problems in community-living older adults.
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Affiliation(s)
| | | | - Berrie Middel
- a Department of Health Sciences , Community and Occupational Medicine and
| | | | - Hubertus P H Kremer
- b Department of Neurology , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
| | - Klaske Wynia
- a Department of Health Sciences , Community and Occupational Medicine and.,b Department of Neurology , University Medical Center Groningen, University of Groningen , Groningen , the Netherlands
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Scholtens S, Smidt N, Swertz MA, Bakker SJL, Dotinga A, Vonk JM, van Dijk F, van Zon SKR, Wijmenga C, Wolffenbuttel BHR, Stolk RP. Cohort Profile: LifeLines, a three-generation cohort study and biobank. Int J Epidemiol 2014; 44:1172-80. [PMID: 25502107 DOI: 10.1093/ije/dyu229] [Citation(s) in RCA: 492] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Nynke Smidt
- LifeLines Cohort Study, Groningen, The Netherlands, Department of Epidemiology
| | | | | | | | - Judith M Vonk
- LifeLines Cohort Study, Groningen, The Netherlands, Department of Epidemiology
| | | | | | | | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronald P Stolk
- LifeLines Cohort Study, Groningen, The Netherlands, Department of Epidemiology
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Uittenbroek RJ, Spoorenberg SLW, Brans R, Middel B, Kremer BPH, Reijneveld SA, Wynia K. [Embrace, a model for integrated elderly care]. Tijdschr Gerontol Geriatr 2014; 45:92-104. [PMID: 24590697 DOI: 10.1007/s12439-014-0062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Ongoing 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 The 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. DISCUSSION This study could provide evidence for the effectiveness of Embrace.
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Affiliation(s)
- R J Uittenbroek
- Afdeling Gezondheidswetenschappen, Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands,
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Spoorenberg SLW, Uittenbroek RJ, Middel B, Kremer BPH, Reijneveld SA, Wynia K. 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. BMC Geriatr 2013; 13:62. [PMID: 23782932 PMCID: PMC3702391 DOI: 10.1186/1471-2318-13-62] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/13/2013] [Indexed: 11/10/2022] Open
Abstract
Background Ongoing 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/Design The 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. Discussion This study could provide evidence for the effectiveness of Embrace. Trial registration The Netherlands National Trial Register NTR3039
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Affiliation(s)
- Sophie L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P,O, BOX 196, 9700 AD, Groningen, The Netherlands.
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