Local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro): study protocol of a randomised comparative effectiveness trial.
Aged
Aged, 80 and over
Chronic Disease
/ therapy
Combined Modality Therapy
Community Networks
Comparative Effectiveness Research
Cost-Benefit Analysis
Disability Evaluation
Female
Germany
Hospitalization
Humans
Interdisciplinary Communication
Intersectoral Collaboration
Male
Multimorbidity
Outcome Assessment, Health Care
Outcome and Process Assessment, Health Care
Precision Medicine
Time Factors
Chronic disease
Collaborative care
Depression
Diabetes
Elderly
Frailty
Multimorbidity
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
04 03 2019
04 03 2019
Historique:
received:
10
01
2019
accepted:
25
02
2019
entrez:
6
3
2019
pubmed:
6
3
2019
medline:
11
1
2020
Statut:
epublish
Résumé
Multimorbid older adults suffering from a long-term health condition like depression, diabetes mellitus type 2, dementia or frailty are at high risk of losing their autonomy. Disability and multimorbidity in the older population are associated with social inequality and lead to soaring costs. Our local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro-Care) aims at improving outcomes for older multimorbid patients with chronic conditions whose social and medical care must be improved. The study will evaluate the effects of LoChro-Care on functional health, depressive symptoms and satisfaction with care, resource utilisation as well as health costs in older persons with long-term conditions. The trial will compare the effectiveness of LoChro-Care and usual care in a cross-sectoral setting from hospital to community care. We will recruit 606 older adults (65+) admitted to local hospital inpatient or outpatient departments who are at risk of loss of independence. Half of them will be randomised to receive the LoChro-Care intervention, comprising seven to 16 contacts with chronic care managers (CCM) within 12 months. The hypothesis that LoChro-Care will result in better patient-centred outcomes will be tested through mixed-method process and outcome evaluation and valid measures completed at baseline and at 12 and 18 months. Cost-effectiveness analyses from the healthcare perspective will include incremental cost-effectiveness ratios. The trial will provide evidence about the effectiveness of local, collaborative, stepped and personalised care management for multimorbid patients with more than one functional impairment or chronic condition. Positive results will be a first step towards the implementation of a systematic cross-sectoral chronic care management to facilitate the appropriate use of available medical and nursing services and to enhance self-management of older people. German Clinical Trials Register (DRKS): DRKS00013904 ; Trial registration date: 02. February 2018.
Sections du résumé
BACKGROUND
Multimorbid older adults suffering from a long-term health condition like depression, diabetes mellitus type 2, dementia or frailty are at high risk of losing their autonomy. Disability and multimorbidity in the older population are associated with social inequality and lead to soaring costs. Our local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro-Care) aims at improving outcomes for older multimorbid patients with chronic conditions whose social and medical care must be improved.
METHODS
The study will evaluate the effects of LoChro-Care on functional health, depressive symptoms and satisfaction with care, resource utilisation as well as health costs in older persons with long-term conditions. The trial will compare the effectiveness of LoChro-Care and usual care in a cross-sectoral setting from hospital to community care. We will recruit 606 older adults (65+) admitted to local hospital inpatient or outpatient departments who are at risk of loss of independence. Half of them will be randomised to receive the LoChro-Care intervention, comprising seven to 16 contacts with chronic care managers (CCM) within 12 months. The hypothesis that LoChro-Care will result in better patient-centred outcomes will be tested through mixed-method process and outcome evaluation and valid measures completed at baseline and at 12 and 18 months. Cost-effectiveness analyses from the healthcare perspective will include incremental cost-effectiveness ratios.
DISCUSSION
The trial will provide evidence about the effectiveness of local, collaborative, stepped and personalised care management for multimorbid patients with more than one functional impairment or chronic condition. Positive results will be a first step towards the implementation of a systematic cross-sectoral chronic care management to facilitate the appropriate use of available medical and nursing services and to enhance self-management of older people.
TRIAL REGISTRATION
German Clinical Trials Register (DRKS): DRKS00013904 ; Trial registration date: 02. February 2018.
Identifiants
pubmed: 30832609
doi: 10.1186/s12877-019-1088-0
pii: 10.1186/s12877-019-1088-0
pmc: PMC6398245
doi:
Banques de données
DRKS
['DRKS00013904']
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
64Références
Age Ageing. 2015 Mar;44(2):213-8
pubmed: 25324330
J Affect Disord. 2013 Jul;149(1-3):14-22
pubmed: 23545062
Age Ageing. 2015 Jan;44(1):162-5
pubmed: 25313241
Cochrane Database Syst Rev. 2012 Feb 15;(2):CD005562
pubmed: 22336813
Health Aff (Millwood). 2013 Jul;32(7):1299-305
pubmed: 23836747
Health Aff (Millwood). 2015 Mar;34(3):431-7
pubmed: 25732493
Clin Psychol Rev. 2011 Apr;31(3):353-60
pubmed: 21382540
J Gen Intern Med. 2001 Sep;16(9):606-13
pubmed: 11556941
Clin Psychol Rev. 2007 Jan;27(1):46-57
pubmed: 16480801
Am J Manag Care. 2012 Feb 01;18(2):e55-60
pubmed: 22435885
Cochrane Database Syst Rev. 2013 Jan 31;(1):CD000313
pubmed: 23440778
Lancet Neurol. 2016 Jan;15(1):116-24
pubmed: 26300044
Lancet Diabetes Endocrinol. 2014 Jan;2(1):56-64
pubmed: 24622669
Lancet Diabetes Endocrinol. 2015 Jun;3(6):461-471
pubmed: 25995124
PLoS One. 2014 Mar 17;9(3):e91973
pubmed: 24638040
Nervenarzt. 2016 Mar;87(3):311-4
pubmed: 26868108
Cochrane Database Syst Rev. 2014 Sep 01;(9):CD009126
pubmed: 25177838
Z Evid Fortbild Qual Gesundhwes. 2013;107(6):386-93
pubmed: 24075680
Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007146
pubmed: 22972103
Int J Qual Health Care. 2014 Oct;26(5):561-70
pubmed: 25108537
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015 Apr;58(4-5):360-6
pubmed: 25648355
Gesundheitswesen. 2015 Jan;77(1):46-52
pubmed: 24806594
Gerontology. 2014;60(5):413-9
pubmed: 24969966
Lancet Diabetes Endocrinol. 2015 Jun;3(6):472-485
pubmed: 25995125
Cochrane Database Syst Rev. 2016 Mar 14;3:CD006560
pubmed: 26976529
Cochrane Database Syst Rev. 2001;(1):CD001481
pubmed: 11279717
Lancet Psychiatry. 2014 Sep;1(4):303-11
pubmed: 26360863
Lancet Diabetes Endocrinol. 2015 Apr;3(4):275-85
pubmed: 25466523
JAMA. 2016 Jan 5;315(1):23-4
pubmed: 26746451
Health Soc Care Community. 2009 Sep;17(5):447-58
pubmed: 19245421
PLoS One. 2014 Sep 29;9(9):e108114
pubmed: 25264616
BMC Health Serv Res. 2011 May 09;11:93
pubmed: 21549010
Qual Life Res. 2007 Nov;16(9):1521-31
pubmed: 17828578
BMC Med. 2014 Dec 08;12:223
pubmed: 25484244
Age Ageing. 2014 Nov;43(6):744-7
pubmed: 25336440
Cochrane Database Syst Rev. 2008 Oct 08;(4):CD001730
pubmed: 18843620
Prev Chronic Dis. 2014 Apr 17;11:E62
pubmed: 24742395
Ont Health Technol Assess Ser. 2013 Sep 01;13(13):1-148
pubmed: 24228076
Cochrane Database Syst Rev. 2011 Nov 09;(11):CD005318
pubmed: 22071821
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012 May;55(5):685-92
pubmed: 22526857
Rev Saude Publica. 2014 Apr;48(2):357-65
pubmed: 24897058
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015 Apr;58(4-5):345-51
pubmed: 25708909
Health Econ Rev. 2015 Dec;5(1):51
pubmed: 26054487