Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Age Ageing. 2024 Jan 2;53(1). doi: 10.1093/ageing/afad249.
BACKGROUND: Fragmentation of services increases health and social care burden as people live longer with higher prevalence of diseases, frailty and dependency. Local evidence for implementing person-centred integrated care is urgently needed to advance practice and policies to achieve healthy ageing. OBJECTIVE: To test the feasibility and impact of World Health Organization's (WHO) Integrated Care for Older People (ICOPE) approach in China. DESIGN: A randomised controlled trial examining the feasibility of implementing ICOPE approach, evaluating its impact on health outcomes and health resource utilisation. SETTING: Primary care setting in urban and suburban communities of Chaoyang District, Beijing, China. SUBJECTS: Community-dwelling older adults screened as at-risk of functional declines and randomised into intervention (537) and control (1611) groups between September 2020 and February 2021. METHODS: A 6-month intervention program following WHO's ICOPE care pathways implemented by integrated care managers compared to standard available care. RESULTS: After 1 to 1 propensity score matching, participants in intervention and control groups (totally 938) had comparable baseline characteristics, demonstrated feasibility of implementing ICOPE with satisfaction by participants (97-99%) and providers (92-93%). All outcomes showed improvements after a 6-month intervention, while statistically significant least-squares mean differences (control-intervention) in vitality (Mini-Nutritional Assessment Short Form to measure vitality, -0.21, 95% CI, -0.40-0.02), mobility (Short Physical Performance Battery to measure mobility, -0.29, 95% CI, -0.44-0.14) and psychological health (Geriatric Depression Scale five items to measure psychological health, 0.09, 95% CI, 0.03-0.14) were observed (P < 0.05). CONCLUSIONS: It is feasible to localise and implement WHO's ICOPE approach in regions with fragmented resources such as China. Preliminary evidence supports its acceptance among key stakeholders and impact on health outcomes.
背景:随着人们寿命的延长,疾病、虚弱和依赖的患病率不断上升,服务碎片化增加了医疗保健负担。为了推进实践和政策以实现健康老龄化,迫切需要为实施以患者为中心的整合护理提供当地证据。
目的:测试世界卫生组织(WHO)老年人综合护理(ICOPE)方法在中国的可行性和影响。
设计:一项随机对照试验,检验 ICOPE 方法实施的可行性,评估其对健康结果和卫生资源利用的影响。
设置:中国北京市朝阳区城乡社区的基层医疗保健机构。
受试者:2020 年 9 月至 2021 年 2 月期间,筛查出有功能下降风险的社区居住的老年人,随机分为干预组(537 人)和对照组(1611 人)。
方法:采用 WHO ICOPE 护理路径的 6 个月干预方案,由综合护理经理实施,与标准现有护理进行比较。
结果:经过 1:1 倾向评分匹配后,干预组和对照组(共 938 名)的参与者具有可比的基线特征,证明了 ICOPE 的实施具有可行性,参与者(97-99%)和提供者(92-93%)均满意。所有结果在 6 个月干预后均有所改善,而在活力(用 Mini-Nutritional Assessment Short Form 测量,差值为-0.21,95%CI-0.40 至 0.02)、活动能力(用 Short Physical Performance Battery 测量,差值为-0.29,95%CI-0.44 至 0.14)和心理健康(用 5 项老年抑郁量表测量,差值为 0.09,95%CI0.03 至 0.14)方面观察到统计学上的最小二乘均数差异(对照组-干预组)(P<0.05)。
结论:在资源碎片化的地区,如中国,本地化和实施世卫组织 ICOPE 方法是可行的。初步证据支持其在主要利益相关者中的接受程度及其对健康结果的影响。
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