ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) Project

Background

Life expectancy is rising in Switzerland, leading to an increasing proportion of home-dwelling older adults needing support and care. However, these services are neither centralized nor coordinated. This fragmentation exposes them to risks such as multiple service use, gaps in information, inappropriate or contradictory recommendations, and medication errors.  Consequently, Switzerland has made efforts to advance integrated care. Integrated care models are complex interventions due to the interactions between components, the behaviours required to deliver the intervention, organizational levels targeted, and outcome variability. Despite evidence supporting their benefits in trial settings, the effectiveness of integrated care for home-dwelling older adults remains mixed in real world settings.  Currently we can’t discern whether unfavorable results stem from design limitations or implementation challenges, and there is limited understanding of how to translate this knowledge into real-world settings. To address these challenges, the University of Basel and Canton Basel-Landschaft (BL) launched the INSPIRE (Implementation of a community-baSed care Program for home dwelling senIoR citizEns) Project following the 2018 Elderly Care and Long-Term Care Act (APG) in Canton BL (22).

Aim

INSPIRE is a multi-phase study that aims to develop, implement and evaluate a nurse-led integrated care model for frail home-dwelling older adults in Canton Basel-Landschaft.

Methods

This is an implementation science project that uses a mixed-methods approach and a hybrid type I design, guided by the recommendations of the Medical Research Council framework for developing and evaluating complex interventions.

Results

Phase A (between 2019 & 2021): involved an evaluation of the strength of evidence, a thorough contextual analysis, the use of different implementation frameworks and models and active stakeholder involvement.  As a result, the INSPIRE care model -a nurse-led integrated care model for frail home-dwelling older adults of 75 and older- was developed alongside with its program theory and a preliminary list of implementation strategies. The final model is a 4-step intervention: a) Screening of frailty; b)Multidisciplinary assessment; c) Individual care plan development and coordination; and d) Follow-up based on needs.

Phase B (between 2022 & 2023): The feasibility and initial implementation of the INSPIRE care model were tested in the Leimental care region of Canton BL. Findings from this evaluation demonstrated good acceptability of the INSPIRE care model among older adults, informal caregivers, and care providers (nurses and social workers). However, the study also revealed the need to improve the model’s reach, fidelity, and feasibility, particularly in components such as individualized care planning and care coordination.

Phase C (starting 2024): This phase will include the evaluation of the impact of the INSPIRE care model on the perception of person centred care in clients of one home-care organization (primary outcome), in comparison to usual care in two other home-care organizations in Canton BL. Additionally, a process evaluation will be conducted to look at mechanisms of impact of the intervention components and implementation strategies on the desired outcomes.