1. The CareWell-primary care program: design of a cluster controlled trial and process evaluation of a complex intervention targeting community-dwelling frail elderly
- Author
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Theo van Achterberg, Henk Schers, Raymond T.C.M. Koopmans, Franca G. H. Ruikes, Gijs van de Wetering, Antoinette R. M. Meys, Betsie G.I. van Gaal, Sytse U Zuidema, and Reinier Akkermans
- Subjects
Program evaluation ,Male ,Activities of daily living ,Cost effectiveness ,Health Services for the Aged ,Cost-Benefit Analysis ,Study Protocol ,Cost of Illness ,QUALITY-OF-LIFE ,Health care ,Quality of nursing and allied health care Quality of Care [NCEBP 6] ,INFORMAL CAREGIVERS ,Activities of Daily Living ,Medicine ,Netherlands ,Chronic care ,Aged, 80 and over ,lcsh:R5-920 ,Integrated care ,Effective primary care and public health [NCEBP 7] ,OLDER PERSONS ,Primary care ,Outcome and Process Assessment, Health Care ,CHRONIC ILLNESS CARE ,GUIDED CARE ,Caregivers ,Regression Analysis ,Female ,Quality-Adjusted Life Years ,Family Practice ,lcsh:Medicine (General) ,Implementation Science [NCEBP 3] ,Process evaluation ,Quality of life (healthcare) ,Nursing ,Complex intervention ,PEOPLE ,Humans ,Alzheimer Centre [NCEBP 11] ,Geriatric Assessment ,Aged ,Primary Health Care ,business.industry ,Functional status ,Frail elderly ,Quality-adjusted life year ,Evaluation of complex medical interventions [NCEBP 2] ,Implementation ,HEALTH-CARE ,Quality of Life ,RANDOMIZED-CONTROLLED-TRIAL ,Cost-effectiveness ,business ,Quality of hospital and integrated care [NCEBP 4] ,Case Management ,Program Evaluation - Abstract
Contains fulltext : 109717.pdf (Publisher’s version ) (Open Access) ABSTRACT: BACKGROUND: With increasing age and longevity, the rising number of frail elders with complex and numerous health-related needs demands a coordinated health care delivery system integrating cure, care and welfare. Studies on the effectiveness of such comprehensive chronic care models targeting frail elders show inconclusive results. The CareWell-primary care program is a complex intervention targeting community-dwelling frail elderly people, that aims to prevent functional decline, improve quality of life, and reduce or postpone hospital and nursing home admissions of community dwelling frail elderly. METHODS/DESIGN: The CareWell-primary care study includes a (cost-) effectiveness study and a comprehensive process evaluation. In a one-year pragmatic, cluster controlled trial, six general practices are non-randomly recruited to adopt the CareWell-primary care program and six control practices will deliver 'care as usual'. Each practice includes a random sample of fifty frail elders aged 70 years or above in the cost-effectiveness study. A sample of patients and informal caregivers and all health care professionals participating in the CareWell-primary care program are included in the process evaluation. In the cost-effectiveness study, the primary outcome is the level of functional abilities as measured with the Katz-15 index. Hierarchical mixed-effects regression models / multilevel modeling approach will be used, since the study participants are nested within the general practices. Furthermore, incremental cost-effectiveness ratios will be calculated as costs per QALY gained and as costs weighed against functional abilities. In the process evaluation, mixed methods will be used to provide insight in the implementation degree of the program, patients' and professionals' approval of the program, and the barriers and facilitators to implementation. DISCUSSION: The CareWell-primary care study will provide new insights into the (cost-) effectiveness, feasibility, and barriers and facilitators for implementation of this complex intervention in primary care. TRIAL REGISTRATION: The CareWell-primary care study is registered in the ClinicalTrials.gov Protocol Registration System: NCT01499797.
- Published
- 2012