Table 4 Data extraction Q3_Models of Care

Strømme et al. [65]

Norway

To describe the outcomes of a competence improvement programme (CIP) for the systematic observation of frail older patients in homecare

Research questions:

(1) How are the outcomes of a CIP in two homecare districts enacted by HCPs?

(2) How do implementation and context influence the CIP outcomes?

Home-based care

Two homecare districts in two municipalities in western Norway

Observations: 21 HCPs

8 registered nurses

9 skilled health workers

4 assistants

Focus groups: 15 HCPs

6 registered nurses

6 skilled health workers

3 assistants

Semi-structured

individual interviews:

5 managers

3 professional development nurses

1 assistant

[age and sex not specified]

Qualitative mixed-method design (QUAL-qual)

Participant observations (145 h)

Focus group interviews; N = 5

Semi-structured individual interviews

Qualitative content analysis

Five concepts characterising the outcomes of the competence improvement programme: Frequency of vital sign measurements; Situational awareness; Expectations and coping level; Activities for sustained improvement; Organisational issues affecting CIP focus

Frailty- HCPs’ skills in recognising and responding to deteriorating frail older patients

The programme was multi-componential and consisted of a written compendium, a digital learning tool, a teaching day, and simulation-based training (including, the ABCDE algorithm and structured communication using ISBAR). An equipment bag, equipment backpacks, and a form to structure observation, decision-making, and communication were included in the programme

Substantial differences were revealed across the two homecare districts in how homecare professionals enacted new knowledge and routines resulting from the competence improvement programme. With one group showing positive changes, while the other showed little change. The differences were related to the frequency of vital sign measurements, coping levels, and situational awareness, in which successful outcomes were shaped by implementation issues and contextual setting. This involved whether routines and planned activities were set to follow up the improvement programme, or whether organisational issues such as leadership focus, resources, and workforce stability supported the programme. Several HCPs in the group with little change considered the need for measuring in homecare as redundant

Islam et al. [66]

Norway

To investigate the impact of introducing a specific model of integrated care for frail elderly patients, the Holistic Continuity of Patient Care (HCPC) programme, specifically whether the HCPC programme contributes to improved health and well-being, experience of care and resource utilisation

Home-based care

N = 209 older people

(mean of mean = 81.73 years old)

IG: 120 older people

(mean = 79.87 years, SD = 9.924♀ = 99.63)

CG: 89 older people

(mean = 83.59 years, SD = 7.831 ♀ = 99.449%)

A quasi-experimental design and linear mixed methods, and conducts a multi-criteria decision analysis (MCDA)

Functional ability and improving patient pathways for older people with frailty

The Integrated care programme focuses on functional ability rather than on disease and impairment. There were three core differences between the HCPC programme and usual care. First, the initial and follow-up (6 weeks) assessment of the patient’s level of functioning by validated tools, second, the “everyday rehabilitation” informed by the patient’s own goals for activities of daily living, third, the early involvement of the patient’s GP, within 2 weeks after enrolment. Additionally, a new professional role was also developed as part of the programme; a designated primary contact (coordinator) working in the municipal care service, notably a nurse or a social worker, responsible for individual patient follow up

The results showed that older patients enrolled in the HCPC program experienced better outcomes compared to those receiving usual care in the municipalities. The MCDA results indicated that HCPC was preferred to usual care irrespective of stakeholders (patients, partners, professionals, policy makers and payers). The better performance of HCPC was mostly driven by improvements in enjoyment of life, psychological wellbeing, and social relationships and participation. Results also reflect that involving more health personnel in HCPC may provide better care but at the cost of more decision-making being left to the professional care providers, which can negatively affect the patients’ feeling of autonomy

Lewis et al. [67]

Ireland

To examine the effect of an established Community Virtual Wards (CVW) on pre-defined health trajectories (between “stable”, “deteriorating”, and “unstable” states) and characteristics that increased the likelihood of adverse healthcare outcomes (hospitalization, institutionalisation and death)

Home-based care

(One Community Virtual Ward in a single centre in Ireland)

88 older people (mean = 82.8 years, SD = 6.4, ♀ = 58)

Non-experimental correlational design using prospective data over a period of 90-day postadmission to the CVW

Delaying or reversing frailty. Supporting older people to remain at home and transitioning from hospital to community

The model of care supported older people to remain at home and transitioning from hospital to community. Care was coordinated by a senior nurse working with other healthcare professionals both in primary and secondary care. The model operated under three levels of CVWs separated to include red (high risk) amber (moderate risk) and green (low risk). The intervention started with a triage phase where home assessment and prioritisation of care needs was done by the senior nurse. Thereafter, the older people were admitted into either the Red (high risk) CVW or the Amber (moderate risk) CVW. Interval assessments were done, and patients transferred to the different levels accordingly

The results show that a CVW model can provide a framework for monitoring and case management to support older people to remain at home or identify those at risk of institutional care. The model has the potential to support a frail older population at home delaying and/or reversing the downward trajectories of frailty. The use of defined health states assisted to stratify those at lower or higher risk. Achieving stability within 30 days and remaining stable at 60 days were associated to remaining at home

Galik et al. [68]

United States of America

The purpose of this study was to test the impact (effectiveness) of Function-Focused Care for the Cognitively Impaired Intervention on nursing home residents with dementia and the nursing assistants who care for them

Facility-based care

N = 180

103 older people with cognitive impairment (mean = 83.7 years, SD = 9.9, ♀ = 79.77%)

77 nursing assistants (mean = 41.60 years, SD = 12.8, ♀ = 96%)

6-month cluster-randomized controlled trial using repeated measures

To support NH staff to actively engaging cognitively impaired residents in functional and physical activities that are person centred

The FFC-CI intervention included four components. First, environment and policy/procedure assessments, including evaluation of the environment and nursing home policy and procedures to determine whether they presented barriers to implementation of a FFC approach. Second, education, including education of nursing home staff and families about FFC (thirty-minute in-service + handouts). Third, developing function focused goals, including person-centred individual resident function and physical activity goals which was initiated through assessment and discussions with the FFC nurse, resident, family, staff, and facility champions. Fourth, mentoring and motivating, including ongoing education and motivation of staff by FFC nurse and facility champions (selected staff)

There were significant improvements in the amount and intensity of physical activity (by survey and actigraphy) and some improvement was seen in physical function in the treatment group. In addition, they were less likely to fall. Nursing assistants were also observed to be providing a greater percentage of function focused care during resident care interactions in the treatment group at 6 months following the completion of baseline measures (even if this was a small, significant increase (63%–66%))

Henskens et al. [69]

the Netherlands

To evaluate the effects of three movement stimulating interventions on QoL and ADL performance in NH residents with dementia

Facility-based care

N = 87 older people with dementia (Age range = 71–100 years, mean (SD) in the four groups = 86.95 (7.21), 86.05 (5.86), 85.14 (4.64), 84.73 (4.55), ♀ = 67)

Mean of mean = 85.7 years old

6-month double parallel randomised controlled trial

Activities of daily living (functional ability/limitations) and quality of life

The intervention was separated into three groups: ADL training alone, a multicomponent exercise training alone, and a combined ADL and exercise training. In the individually based ADL training intervention, nursing staff were asked to stimulate movement during daily care tasks by encouraging residents to perform as much of their self-care as independently as possible throughout the day. The multicomponent exercise training intervention consisted of strength and aerobic exercises, three times per week, for 30–45 minutes per sessions, guided by qualified movement teachers. For each ward per ADL location, ambassadors, including two nursing staff, received three 3-hour educational sessions by qualified physio- and occupational therapists. These individuals were then responsible for sharing their knowledge with the other nursing staff

No effects were found of the three movement interventions on ADL performance. Although no effects were found of ADL training on ADL performance, an observed trend showed a maintenance in ADL performance in the ADL group, and a decline in the care-as-usual group. Although these differences were not significant, maintenance in ADL is considered a positive finding, as NH residents with dementia typically experience a decline in ADL performance

Kerse et al. [70]

New Zealand

To assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care

Facility-based care

N = 682 older people (mean = 84,3 years, SD = 7,2, ♀ = 502)

IG = 330 (mean = 84.4 years, SD = 7.2, ♀ = 240)

CG = 352 (mean = 84.1 years, SD = 7.2, ♀ = 262)

(Pragmatic) cluster randomised controlled trial with one year follow-up

Function, quality of life and falls

Note: In seven of the 41 homes, the assessor was unblinded at some time during follow-up. This potentially affected measures on 56 activity participants and 41 social participants

The intervention group were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants. There was a focus on imbedding the activities in the daily activities. The intervention included: goal setting, functional assessment and activity programme design, staff implementation (training of healthcare assistants) and ongoing support. In the control group the residents received usual care and social visits

The goal-oriented programme based on activities of daily living had no impact overall. However, in contrast to residents with impaired cognition, those with normal cognition in the intervention group may have maintained overall function and lower limb function. Still no changes occurred in observed function, quality of life, or falls. Neither achievement of goals nor compliance made any difference to improvement in function. Residents with impaired cognition showed no maintenance of function and the likelihood of depression increased in the intervention group. No other outcomes differed between groups