Affiliation:
1. Institute for Sustainable Health and Optimal Aging, University of Louisville, Kentucky
2. Kent School of Social Work, University of Louisville, Kentucky
3. Department of Social Work, University of the Free State, Bloemfontein, South Africa
4. School of Medicine, University of Louisville, Kentucky
5. Kentuckiana Regional Planning and Development Agency, Area Agency on Aging, Louisville, Kentucky
Abstract
Abstract
Background and Objectives
In evaluating integrated care models, traditional quality measures do not account for functional and quality of life factors, affecting older adults with multiple chronic conditions. The objective of this study was the development and validation of the Flourish Index (FI), an instrument to evaluate integrated care, using a determinants of health model.
Research Design and Methods
The study took place within the evaluation study of the Flourish Model (FM). The FM provides care coordination services using an integrated primary care and community-based services model. Baseline data from 70 older adults were used in the validation study. Twenty-seven quality of care indicators within six determinants of health, namely biological, psychological, individual health behaviors, health services, environmental, and social, formed part of the FI.
Results
Categorical principal components analysis showed a 5-dimensional structure with psychological determinants loading on the biological determinants of health. Internal consistency (Cronbach’s alpha) for the determinants was as follows: biological/psychological = 0.73, individual = 0.58, environmental = 0.62, health services = 0.65, social = 0.67, total score = 0.97. Sensitivity to change was shown for the total FI score (F1,22 = 8.82, p = .01) and social (F1,22 = 5.82, p = .02), with a trend toward sensitivity for individual health behaviors (F1,22 = 3.95, p = .06) and health services (F1,22 = 3.26, p = .09).
Discussion and Implications
The preliminary analysis of the FI shows promise for the usability of the index to provide insight into the fundamental challenges of aging. It brings greater clarity in caring for older adults and supports quality evaluation of integrated care coordination models.
Funder
Health Resources and Services Administration
Publisher
Oxford University Press (OUP)
Subject
Geriatrics and Gerontology,Gerontology,General Medicine
Reference60 articles.
1. Factors influencing older adults to complete advance directives;Alano;Palliative and Supportive Care,2010
2. Psychological perspectives on successful aging: The model of selective optimization with compensation;Baltes,1990
3. Conjoint screening questionnaires for alcohol and other drug abuse: Criterion validity in a primary care practice;Brown;Wisconsin Medical Journal,1995
4. Preparing patients and caregivers to participate in care delivered across settings: The care transitions intervention;Coleman;Journal of the American Geriatrics Society,2004
5. Closing the gap in a generation: Health equity through action on the social determinants of health;Commission on Social Determinants of Health,2008
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