Background: To provide value-based care for patients with multi-morbidity, innovative integrated care programmes and comprehensive evaluations of such programmes are required. In Norway, a new programme called “Holistic Continuity of Patient Care” (HCPC) addresses the issue of multi-morbidity by providing integrated care within learning networks for frail elderly patients who receive municipal home care services or a short-term stay in a nursing home. This study conducts a multi-criteria decision analysis (MCDA) to evaluate whether the HCPC programme performs better on a large set of outcomes corresponding to the ‘triple aim’ compared to usual care. Methods: Prospective longitudinal survey data were collected at baseline and follow-up after 6-months. The assessment of HCPC was implemented by a novel MCDA framework. The relative weights of importance of the outcomes used in the MCDA were obtained from a discrete choice experiment among five different groups of stakeholders. The performance score was estimated using a quasi-experimental design and linear mixed methods. Performance scores were standardized and multiplied by their weights of importance to obtain the overall MCDA value by stakeholder group. Results: At baseline in the HCPC and usual care groups, respectively, 120 and 89 patients responded, of whom 87 and 41 responded at follow-up. The average age at baseline was 80.0 years for HCPC and 83.6 for usual care. Matching reduced the standardized differences between the groups for patient background characteristics and outcome variables. The MCDA results indicated that HCPC was preferred to usual care irrespective of stakeholders. The better performance of HCPC was mostly driven by improvements in enjoyment of life, psychological well-being, and social relationships and participation. Results were consistent with sensitivity analyses using Monte Carlo simulation. Conclusion: Frail elderly with multi-morbidity represent complex health problems at large costs for society in terms of health- and social care. This study is a novel contribution to assessing and understanding HCPC programme performance respecting the multi-dimensionality of desired outcomes. Integrated care programmes like HCPC may improve well-being of patients, be cost-saving, and contribute to the pursuit of evidence based gradual reforms in the care of frail elderly.
Bibliographical noteFunding Information:
The authors are grateful to two anonymous referees for helpful comments and suggestions. We are also thankful to many different organisations and individuals for their valuable support during study initiation and data collection process. Our sincere thanks go to Sigrid Askum and Torun Risnes from Norwegian association of local and regional authorities; Anders Vege from Norwegian Institute of Public Health; Anders Grimsmo from Norwegian Health Network; research assistants, Tord Lauvland Bjornevik and Nina Lunde; to all participating municipalities.
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634288. The funder had no role in the design of the study; in the collection, analysis, and interpretation of data; and in writing the manuscript. The content of this report reflects only the SELFIE groups’ views and the European Commission is not liable for any use that may be made of the information contained herein.
© 2021, The Author(s).