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

Sophie Lw Spoorenberg,Sijmen A Reijneveld,Klaske Wynia,Berry Ph Kremer,Ronald J Uittenbroek,Berrie Middel

doi:10.1186/1471-2318-13-62

Sophie Lw Spoorenberg, Sijmen A Reijneveld + Show 4 more

Open Access

https://doi.org/10.1186/1471-2318-13-62

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Abstract

BackgroundOngoing 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/DesignThe 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.DiscussionThis study could provide evidence for the effectiveness of Embrace.Trial registrationThe Netherlands National Trial Register NTR3039

Highlights

Ongoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide
Outcome measurements The aim of this study is to investigate whether Embrace improves patient outcomes and quality of care in a costeffective way for all community-living elderly people
To our knowledge, the Embrace study is the first randomized controlled trial (RCT) that studies the effectiveness, including cost-effectiveness, of an integrated care model that is based on all Chronic Care Model (CCM) elements and is applied to a community sample of elderly people

Summary

Introduction

Ongoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. Structural and financial barriers have further increased the segmentation of organizations that provide primary and secondary care, health care, and social care [1,3,8] This fragmentation of care negatively affects the provision of integrated long-term care and support for the chronically ill and for elderly people with complex care needs [5,9]. Despite the wide array of health services they use, these patients do not always receive appropriate and coherent care [4,10,11] This often leads to adverse drug events, difficulties with participation in treatment, and even treatment errors [4,8,12]. Health care systems need to be transformed [3,7,8]

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