P.H.J.TENG1, N.H.L. HA1, H.T.R. TAN1, Z.L. NAI1, W.S. LIM1, Y.Y. DING1, W.S. TAN1
Geriatric Education and Research Institute1
The Geriatric Services Hub (GSH) is a piloted by five hospitals to provide referral-gated and frailty-related services for older adults in the community. However, each GSH was designed differently, and such complex interventions are rarely described in detail. Thus, we aim to describe key features of each care model and assess their early implementation outcomes.
Using purposive sampling, we conducted interviews with fourteen key informants across five sites and adapted the conceptual framework for integrated care by Kodner and Kyriacou to guide this qualitative inquiry. Also, we corroborated the qualitative findings with quantitative process indicators.
A thick description of each model was developed from the interviews. Broadly, the programmes are led by primary care (supported from geriatricians), community nurses, or a geriatrician. Twelve factors from Kodner and Kyriacou’s framework were used to analyse the descriptions and we found that sites had tried to develop all factors but adopted different strategies. Their approaches were influenced by factors such as the organisational leadership and resources of different hospitals. The different strategies affected the early implementation outcomes of each model. For example, the take-up rates across sites ranged 32.3%–100%, while mean referrals to services ranged 0.43–2.22 per patient.
From the same broad principles, each hospital site had conceptualised a different GSH model of care. This poses a challenge in evaluation and transferability of findings. Thus, it becomes imperative to develop a framework-based thick description of such interventions as a first step towards effective evaluation and replication.