Establishing the core elements of a frailty at the front door model of care using a modified real-time Delphi technique

BACKGROUND

Innovations in models of care for older adults living with frailty presenting to the emergency department (ED) have become a key priority for clinicians, researchers and policymakers due to the deleterious outcomes older adults experience due to prolonged exposure to such an environment. This study aimed to develop a set of expert consensus-based statements underpinning operational design, outcome measurement and evaluation of a Frailty at the Front Door (FFD) model of care for older adults within an Irish context.

METHODS

A modified real-time Delphi method was used. Facilitation of World Café focus groups with an expert panel of 86 members and seperate advisory groups with a Public and Patient Involvement panel of older adults and members of the Irish Association of Emergency Medicine generated a series of statements on the core elements of the FFD model of care. Statements were analysed thematically and incorporated into a real-time Delphi survey, which was emailed to members of the expert panel. Members were asked to rank 70 statements across nine domains using a 9-point Likert scale. Consensus criteria were defined a priori and guided by previous research using 9-point rating scales.

RESULTS

Fifty members responded to the survey representing an overall response rate of 58%. Following analyses of the survey responses, the research team reviewed statements for content overlap and refined a final list of statements across the following domains: aims and objectives of the FFD model of care; target population; screening and assessment; interventions; technology; integration of care; evaluation and metrics; and research.

CONCLUSION

Development of a consensus derived FFD model of care represents an important step in generating national standards, implementation of a service model as intended and enhances opportunities for scientific impact. Future research should focus on the development of a core outcome set for studies involving older adults in the ED.

A realist process evaluation of an intervention to promote competencies in interprofessional collaboration among interdisciplinary integrated care teams for older people: Study protocol

Background: International policy is increasingly committed to placing interdisciplinary team-working at the centre of health and social care integration across the lifespan. The National Clinical Programme for Older People in Ireland has a critical role in the design and implementation of the National Older Person's Service Model, which aims to shift the delivery of care away from acute hospitals towards community-based care. Interdisciplinary Community Specialist Teams for older persons (CST-OPs) play an important role in this service model. To support the development of competencies for interprofessional collaboration and an interdisciplinary team-based approach to care integration, a culture shift will be required within care delivery. Design:This study builds upon a collaborative partnership project which co-designed a framework describing core competencies for interprofessional collaboration in CST-OPs. A realist-informed process evaluation of the framework will be undertaken as the competencies described in the framework are being fostered in newly developed CST-OPs under the national scale-up of the service model. Realist evaluation approaches reveal what worked, why it worked (or did not), for whom and under what circumstances. Three iterative and integrated work packages are proposed which combine multiple methods of data collection, analysis and synthesis. Prospective data collection will be undertaken within four CST-OPs, including qualitative exploration of the care experiences of older people and family carers. Discussion: The realist explanatory theory will provide an understanding of how interprofessional collaboration can be fostered and sustained in various contexts of care integration for older people. It will underpin curriculum development for team-based education and training of health and social care professionals, a key priority area in the national Irish health strategy. It will provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and to realise the goals of integrated care for older people.

151 A CROSS-SECTIONAL EXPLORATION OF INTERPROFESSIONAL COLLABORATION WITHIN INTEGRATED CARE TEAMS OPERATING UNDER THE NATIONAL INTEGRATED CARE PROGRAMME FOR OLDER PERSONS

Background

There is an evidence and practice gap in understanding the knowledge, skills, and behaviours required of Health Care Professionals (HCPs) for effective interprofessional collaboration in the context of integrated care for older people. Furthermore, little is known about the outcome factors that may be associated with effective interprofessional collaboration among HCPs working in integrated care teams for older people.

Methods

A cross-sectional representative survey of HCPs employed in the 30 integrated care teams (ICTs) operating under the National Integrated Care Programme for Older Persons was undertaken. The survey measured indicators of competence identified in a previously co-designed framework for core competencies for interprofessional collaboration within ICTs for older people.

Results

The study explores an association between competencies in interprofessional collaboration among HCPs employed in ICTs for older persons and factors associated with higher job satisfaction including psychological safety, trust, and work engagement. Findings elaborate on instances of service innovation which resulted from interprofessional collaboration within the team.

Conclusion

The study findings provide a baseline understanding of competencies for interprofessional collaboration within the ICTs operating in the NICPOP. This will support an implementation evaluation of the co-designed framework that will generate realist evidence regarding how ICTs for older people foster, enhance and sustain their proficiency in interprofessional collaboration. This realist evaluation will identify new models of interprofessional team working and explore the outcomes that are associated with interprofessional collaboration from the perspective of older people, their family carers, and HCPs who are working as part of an interprofessional team.