This randomized controlled trial aims to evaluate the effectiveness and cost-effectiveness of the Interprofessional Health Needs Assessment (IHNA) in older adults living at home. Specifically, the trial will assess the effects of IHNA on health-related quality of life, social care-related quality of life, survival, and health service utilization. The primary objective is to determine the effect of IHNA on participants' health-related quality of life at 12 months. Secondary objectives are to assess its effects on social care-related quality of life, survival (time to death), health service utilization, and quality-adjusted life years (QALYs) at 6 and 12 months.
Early identification of health needs among home-dwelling elderly adults is crucial for maintaining health and function, improving quality of life, and preventing hospitalizations. When allocating municipal health and care services, healthcare professionals assess functional abilities and health needs. Based on this assessment, services such as emergency alarms, everyday rehabilitation, home nursing care, practical assistance at home, and assistive devices are assigned. However, there is no standardized approach to what should be included in these assessments or how they should be conducted. This project develops a procedure for interprofessional health needs assessment (IHNA) to systematically identify and address the health needs of older adults living at home. IHNA integrates the older adult's values and preferences into the assessment, ensuring that interventions and services align with their priorities. IHNA incorporates screening tools to provide a structured, holistic assessment of health and social domains. The project involves co-creation of IHNA with healthcare professionals and older adults, workplace training in the effective use of IHNA, and implementation in two Norwegian municipalities through a randomized controlled trial. By developing interprofessional practices for assessing health needs and equipping healthcare professionals with screening tools and training, the project will help municipalities provide fairer, more effective services to home-dwelling older adults.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE
Enrollment
200
Interprofessional teams with a nurse, physiotherapist, or occupational therapist from Stavanger and Sandnes municipalities will assess participants in the intervention group using the Interprofessional Health Needs Assessment (INHA) procedure. INHA includes screening tools to assess mobility, cognition, mental health, nutrition and oral health, vision and hearing, activities of daily living, social network, physical and behavioral health. Based on the IHNA findings, the interprofessional teams, in collaboration with the older adult, will decide on the allocation of municipal health services, make referrals, and provide advice on available preventive and health promotion interventions from the municipality's health and care services and relevant voluntary and private actors.
Sandnes Municipality
Sandnes, Norway
RECRUITINGStavanger Muncipality
Stavanger, Norway
RECRUITINGHealth-related quality of life
Health-related quality of life will be assessed using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L). The EQ-5D-5L descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has five response levels: no problems, slight problems, moderate problems, severe problems, and extreme problems/unable to perform. Responses are combined into a 5-digit health-state profile, with 11111 representing the best health state and 55555 the worst health state. Health state will be converted into a utility index score, with higher scores indicating better health-related quality of life. The primary outcome will be the change in EQ-5D-5L utility index score from baseline to 12 months.
Time frame: Baseline, 6 months and 12 months
Self-rated health
The EuroQol Visual Analog Scale (EQ VAS) will be assessed as a secondary outcome measure of self-rated health. Participants rate their current health on a scale from 0 to 100. A score of 100 is equivalent to the best possible health. A score of 0 is equivalent to the worst possible health. Changes in EQ VAS scores from baseline to 6 months and 12 months will be evaluated, with higher scores indicating better perceived health.
Time frame: Baseline, 6 months, and 12 months
Social care related quality of life
The Adult Social Care Outcomes Toolkit (ASCOT) will be used as a secondary outcome measure of social care-related quality of life. ASCOT covers eight domains: control over daily life, personal cleanliness and comfort, food and drink, personal safety, social participation and involvement, occupation, accommodation cleanliness and comfort, and dignity. Each domain has four response options scored from 0 to 3, with higher scores indicating better outcomes. Domain responses will be combined into an overall ASCOT score, with higher scores indicating better social care-related quality of life. Changes in ASCOT scores from baseline to 6 months and 12 months will be evaluated.
Time frame: Baseline, 6 months, and 12 months
Time to death (survival)
Time from baseline to death within 12 months will be obtained from municipal electronic patient records. Longer survival indicates a better outcome.
Time frame: Baseline to 12 months
Health care utilization
Health care utilization will be assessed as a secondary outcome measure. Data on nursing home admissions, municipal emergency service visits, and hospital admissions will be obtained from the Norwegian Registry for Primary Health Care and the Norwegian Patient Registry. Health care utilization will be measured as the number of nursing home admissions, municipal emergency service visits, and hospital admissions during the 6- and 12-month follow-up periods. Lower health care utilization indicates better outcomes.
Time frame: 6 and 12 months
Quality-Adjusted Life Years ( QALYs)
Quality-Adjusted Life Years (QALYs) will be a secondary outcome, measuring the combined effects of the intervention on survival and health-related quality of life. QALYs will be calculated over the 12-month follow-up period by combining survival with health utility values derived from the EQ-5D. Higher QALYs indicate better overall health outcomes. QALY estimates will be used to inform cost-effectiveness analyses.
Time frame: Baseline, 6 months and 12 months
Arnt Egil Ydstebø
CONTACT
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