Effectiveness of Integrated Care Network

Not Applicable

Completed

• Conditions: Fragility; Multimorbidity
• Interventions: Behavioral: Multi-domain intervention

• Registration Number: NCT03528005
• Lead Sponsor: National Yang Ming Chiao Tung University

Brief Summary

This project aims to examine the effectiveness of the community-based integrated care service model , based on a multi-domain intervention program, among community-dwelling older adults. Moreover, the investigators use the value-based healthcare standard set as well as comprehensive geriatric assessment as outcome measures and to use the randomized controlled trial design to validate the clinical effectiveness.

Detailed Description

Population aging and the progress of medical technology are two main causes for the increase of healthcare expenditure. Effective management of medical expenditure and maintenance of health care quality have become the most important task for the public health and clinical care services. Both United Kingdom and the World Health Organization proposed introducing interdisciplinary team care to improve health of older people and to maximize their independence. Prof Michael Porter has addressed the current difficulty of healthcare system, and proposed that healthcare system should pursuit long-term outcome to promote the value of health care. This project aims to echo the international trends, using Taiwan healthcare system as the basis to establish the community-based integrated care service model, and to use the randomized controlled trial design to validate the clinical effectiveness.

Study Timeline

• Study First Submitted: 2018-04-24
• Study First Submitted QC: 2018-05-05
• Study First Posted: 2018-05-17
• Study Start: 2018-06-25
• Primary Completion: 2020-03-14
• Study Completion: 2020-03-14
• Status Verified: 2020-04
• Last Update Submitted: 2020-04-20
• Last Update Posted: 2020-04-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 398

Inclusion Criteria

• age ≧ 65 years
• three or more chronic conditions, defined by National Health Insurance list of chronic conditions
• covered by National Health Insurance

Exclusion Criteria

• could not understanding protocol or communication with research nurses
• malignant diseases under active treatments
• life expectancy less than twelve months
• admitted in the long term facility

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Multi-domain intervention	Multi-domain intervention included exercise,cognitive training, diet education, and disease consultation was conducted for two hours twice per week in the first month, once per week in the second month, and once per month since third month.

Primary Outcome Measures

Name	Time	Method
Changes from baseline life quality at 3, 6, 9, 12 month	baseline, 3, 6, 9, 12 month	measured by the 36-Item Short Form Health Survey (SF-36).

Secondary Outcome Measures

Name	Time	Method
Changes from baseline standard set of health outcome measures for older persons at 3, 6, 9, 12 month	baseline, 3, 6, 9, 12 month	a standard health care set proposed by the International Consortium for Health Outcomes Measurement (ICHOM)

Trial Locations

Locations (6)

Taipei Veterans General Hospital Yuanshan Branch; 🇨🇳 Yilan, Taiwan

Hualien Tzu Chi Hospital,Buddhist Tzu Chi Medical Foundation; 🇨🇳 Hualien City, Taiwan

Cheng's primary care clinic; 🇨🇳 New Taipei City, Taiwan

National Yang-Ming University Hospital; 🇨🇳 Yilan, Taiwan

Shulin Primary Care center; 🇨🇳 New Taipei City, Taiwan

Yingge Primary Health Care center; 🇨🇳 New Taipei City, Taiwan