Establishing the aims, format and core standards of a frailty at the front door model of care: a mixed methods consensus study

Abstract

Background: Substantial investment has been given to scale up of Frailty at the Front Door (FFD) teams in Ireland. These teams reflect a component of an integrated model of care developed by the National Clinical Programme for Older People (NCPOP) and give practical expression to implementing bespoke pathways for older people living with frailty. The aim of the FFD team is to improve the experience and outcomes of older people >65 living with frailty presenting to emergency and acute care services. Whilst scale up is advancing, further collaborative work is required to agree a set of core standards and recommendations to ensure consistency of design, implementation, and evaluation. 
 Aim: To build national multi-stakeholder consensus on the core components and standards of the FFD model of care for older adults.
 Methods: This was a mixed methods study comprising World Café focus groups and a Delphi methodology. Utilising a participatory approach, World Café focus groups were conducted with FFD key stakeholders (n=88) including patient representatives. Participants discussed key pillars of the FFD model of care with the aim of developing a set of evidence-based interventions and recommendations. Thematic analysis was completed using NVivo software. Insights from the World Café focus groups were used to develop the online Delphi survey. Engagement with a Public and Patient Involvement (PPI) panel of older adults and informal caregivers were incorporated to guide the development of the survey. This was designed using an online survey tool, Qualtrics. The survey was designed to obtain specific information from participants in Likert scale format. The Delphi survey was emailed to participants from the initial World Café consensus event in November 2022 and a real time approach is being employed whereby participants will be informed of aggregated responses until formal consensus is reached.
 Results: Data collection is ongoing with consensus on the core components and standards of the FFD model of care expected in Spring 2023.
 Impact: FFD teams are a valuable component on an integrated care pathway for older persons. Differences have emerged in terms of operational delivery, clinical design and evaluation as a result of their emergent nature. This mixed methods study using a co-design approach will support an evidence-based, patient sensitive model of care that will ensure consistency of approach and outcomes.