SPEC study: evaluation of a technology-enhanced, integrated care model in nursing homes

INTERVENTION: The Systems for Person‐centered Elder Care (SPEC) study is a stepped‐wedge cluster randomized trial to evaluate a technology‐enhanced, integrated care model for frail seniors in long‐term care facilities in South Korea. The SPEC is a new, person‐centered, multidisciplinary, integrated care management model enhanced by technology, targeting older residents at risk for common geriatric conditions and problems. The SPEC model was guided by the Chronic Care Model (CCM) and the CCM‐inspired Multidisciplinary Integrated Care (MIC) model tested at residential care homes in the Netherlands. The key elements of the multifaceted SPEC intervention are as follows: 1. Comprehensive geriatric assessment (CGA) and need/risk profiling of triggered common geriatric problems using a decision‐support tool, promoting a whole‐person approach 2. Individualized need‐based care planning (CP) using standardized care protocols and checklists by nurse/social worker pair‐led multidisciplinary care teams, with input from the patient/family regarding preferences and choices in order to promote their service engagement 3. Optional multidisciplinary case conference meetings for older people who are at high risk and have complex care needs 4. Coordination of care through collaboration with families, contracted physicians, and/or medical institutions 5. An information and communication system supporting and tracking the entire care management process, including CGA and CP, as described above; and also provision of tailored resources for care providers/managers and older adults/families. Education, training, and structured on‐ and off‐line support will be provided. Ten nursing homes will participate in the study. The intervention will be sequentially rolled out every 3 months to two nursing homes in random order. Each participating nursing home will receive the intervention for approximately 6 months following a control period during which the usual care will be provided. The overall study period w CONDITION: Chronic illness; functional health ; Not Applicable PRIMARY OUTCOME: Quality of care (composite score of quality indicators of the interRAI LTCF) [Time frame: baseline, 3 months, 6 months, and 9 months of participant enrollment] INCLUSION CRITERIA: Institutions: 1. Nursing homes designated as long‐term care institutions by the National Health Insurance Services in Korea 2. Nursing homes with at least 45 residents 3. Nursing homes that agree to participate Residents: 1. Adults aged 65 or older 2. Older adults that agree to participate Staff: 1. Staff working at the nursing homes involved in the study 2. Staff that agree to participate SECONDARY OUTCOME: 1. Quality of care (individual quality indicators of the interRAI LTCF) [Time frame: baseline, 3 months, 6 months, and 9 months of participant enrollment] ; 2. Care needs (identified clinical action points using the interRAI LTCF) [Time frame: baseline, 3 months, 6 months, and 9 months of participant enrollment] ; 3. Functional health (the Bathel index; Mini‐Mental Status Examination; Patient Health Questionnaire) [Time frame: baseline, 3 months, 6 months, and 9 months of participant enrollment] ; 4. Quality of life (EuroQol EQ5‐D; interRAI HRQoL) [Time frame: baseline, 3 months, 6 months, and 9 months of participant enrollment], (interRAI Self‐reported QoL) [Time frame: 3 months and 9 months of participant enrollment]; 5. Patient satisfaction (Client Satisfaction Questionnaire) [Time frame: 3 months, and 9 months of participant enrollment] ; 6. Health care utilization (hospital admissions; emergency department visits) [Time frame: 21 months]; 7. Cost parameters (direct and indirect cost) [Time frame: 21 months]; 8. Process evaluation (mixed methods) [Time frame: 21 months]; ; Other measures: Care staff/organization ; 1. Empowerment (Psychological Empowerment Instrument) [Time frame: 3 months and 9 months]; 2. Communication satisfaction (Communication Satisfaction Questionnaire) [Time frame: 3 months and 9 months]; 3. Organizational commitment (Organizational Commitment Questionnaire) [Time frame: 3 months and 9 months]; 4. Job satisfaction (Job Satisfaction Scale) [Time frame: 3 months and 9 months]; 5. Technology/innovation acceptance (modified Technology Acceptance Model Questionnaire) [Time frame: 4 months and 9 months]