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.

Sophie L W Spoorenberg,Klaske Wynia,Hubertus P H Kremer,Ronald J Uittenbroek,Sijmen A Reijneveld,Catherine J Evans

doi:10.1371/journal.pone.0190751

Sophie L W Spoorenberg, Klaske Wynia + Show 4 more

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https://doi.org/10.1371/journal.pone.0190751

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Abstract

ObjectiveTo 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.MethodsEmbrace 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.Results1456 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.ConclusionsThis 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.

Highlights

Older adults prefer to remain living at home for as long as possible–‘to age in place’–and to participate in society [1,2,3]
Between October 2011 and March 2013, we conducted a randomised controlled trial (RCT) with stratification into three risk profiles based on the level of frailty and complexity of care needs and balanced allocation within general practitioner (GP) practices to the intervention (Embrace) or care as usual (CAU) groups
Non-respondents differed from respondents regarding gender, age and degree of urbanisation (S1 Table)

Summary

Introduction

Older adults prefer to remain living at home for as long as possible–‘to age in place’–and to participate in society [1,2,3]. This preference is compromised by age-related health problems [4,5], leading to an increasing level of dependency and service-use, a growing sense of loss of control and insecurity, and the threat of ultimate relocation to an institution [6,7,8,9]. In order to provide care and support to the total community-living population of older adults, the CCM can be combined with a Population Health Management (PHM) model. PHM-based care and support can be targeted to individual needs by classifying population subgroups into risk profiles [17]

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