FlourishCare Model of Integrated Care: The Validation of the Flourish Index-Revised (FI-R)

Abstract

Abstract Background and Objectives This study validates the Flourish Index–Revised (FI-R), a tool evaluating integrated health care models. The original Flourish Index (FI) was developed in 2018 (Faul et al., 2018) and has been refined to align with the FlourishCare (FC)TM Model (Model) for geriatric primary care. Research Design and Methods The Model provides integrated biopsychosocial health care to older adults. The FI-R uses 25 quality-of-care indicators and 7 contextual community indicators. The FI-R was validated with Categorial Principal Components Analysis (CATPCA) using a sample of 949 patients 50+ who were mostly female (73%), Non-Hispanic White (70%), living in urban areas (90%), and married (29%), single (22%) or divorced (19%). The mean age was 73.46 (SD=10.86) and mean years of education was 14.30 (SD=2.14). Results CATPCA showed a four-dimensional structure of biological, psychological, and two social determinants of health (SDOH) subdomains: health behaviors and community. Final selection of indicators was based on total variance accounted for >0.30, absolute values of item loadings >0.45, and not having cross loadings >0.45 on two factors. Internal consistency (Cronbach Alpha) for the determinants were: biological=0.75, psychological=0.76, SDOH: community=0.70, SDOH: Health Behaviors=0.50 and total FI-R=0.95. Sensitivity to change was shown for the total FI-R, psychological determinants, and SDOH:health behaviors but not for biological determinants. Discussion and Implications The validation of the FI-R shows promise for its usability to evaluate integrated health care models using existing measures in electronic health systems. More work is needed to improve the incorporation of SDOH:sociodemographics into the FI-R.