Mapping service delivery models that optimize quality of life and health services use among older people
Implementations
Implementing partners
Phase 1Lead research institutions: King’s College, London and University of Southern California (USC)
Other participating institutions: Kobe University, Japan; Kyoto University, Japan; Ashiya Municipal Hospital, Japan and Catalan Institute of Oncology, Barcelona, Spain
Principal investigators: Dr Matthew Maddocks and Dr Catherine Evans, King’s College, London; and Dr Joanne Yoong and Ms Lila Rabinovich, University of Southern California
Location of research
Phase 1Global
Total budget
| Phase 1: | US$ | 40 000.00 |
| Phase 2: | US$ | 142 000.00 |
Background
As populations age, health and social services need to be realigned towards older populations to optimize their functioning and quality of life (QOL). This requires fundamental changes to health systems and service delivery to meet the needs of older people and achieve intended outcomes, particularly for those with advancing chronic disease.
Phase 1: In 2017, researchers completed a rapid review of systematic reviews on the effectiveness of service models aiming to optimize QOL for older people. Of 2238 identified, 72 systematic reviews were retained. Service models broadly classified as to whether they targeting physical functioning or focused on symptoms. However, the study could not draw conclusions about which service delivery model contributed to specific outcomes, nor could it describe which models would work in resource constrained settings in low and middle-income countries (LMIC).
Phase 2: To address the gaps in Phase 1, undertake a tertiary review of primary literature to map service delivery models to specific outcomes that optimize both quality of life and health services use for older people, and describe the elements that are needed for the models to work in other contexts.
Phase 2 Methods
To analyze the primary studies identified from the original scoping review and evaluate linkages between service delivery models, their elements, organization and delivery to describe how intended outcomes for older populations.
Findings
Common elements of services that optimize quality of life and health service use in older people include a comprehensive and ongoing assessment of needs and sufficient time for this to occur. Enabling factors include patient engagement, participation and self-management.
Facilitating health systems factors including skilled workforce, systems that enable interdisciplinary coordination, referral systems to enable access to specialized care, and family support systems.
The study failed to draw associations between the health systems elements and health outcomes or care utilization.
The study noted that there was insufficient evidence to assess the impact of bereavement support for carers, integration of health and social care, and the use of volunteers and community-based organisations.
Publications
Evans et al. Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review. Milbank Quarterly, 2019; 97(1): 113-175. https://onlinelibrary.wiley.com/doi/full/10.1111/1468-0009.12373