Personalised care planning to improve quality of life for older people with frailty

Aims The overarching aim is to establish whether personalised care planning (PCP) for older people with frailty improves quality of life and reduces health and social care resource use at 12 months. Research questions How should PCP be targeted and resource use modelled across the frailty spectrum? How should PCP be optimised for older people with frailty? Is it feasible to conduct a cluster randomised controlled trial to evaluate PCP? Does PCP for older people with frailty improve quality of life and reduce health and social care resource use? Background and rationale Care for older people with frailty should be proactive and person-centred rather than reactive and disease focused. Personalised care planning (PCP) is a promising way to achieve this necessary shift. Age UK have developed an integrated care service to provide PCP in frailty, but the intervention has not yet been optimised and lacks rigorous evidence of effectiveness. We have developed, validated and implemented an electronic frailty index (eFI) that uses routinely available primary care data to identify the presence and severity of frailty in older people as the necessary first step in providing PCP. Research plan We propose to refine the target population for PCP using the eFI, and optimise PCP by evaluating the Age UK integrated care service against the underlying intervention theory. Following feasibility testing, we plan to evaluate the clinical and cost-effectiveness of the optimised PCP intervention in a definitive cluster RCT. WP1: Refining the target population by exploring resource use and quality of life in frailty We will use the eFI to investigate health and social care resource and quality of life data to refine the target population for PCP. We will analyse data from participants in the English Longitudinal Study of Ageing (ELSA), the Community Ageing Research 75+ (CARE 75+) study and the ResearchOne database, and use quality of life data from CARE 75+ to refine the target population, model resource use and develop a decision-analytic model. WP2: Optimising PCP for older people with frailty We will draw on social cognitive theory as the basis for intervention optimisation. We will review existing literature and conduct a detailed case study in up to four existing Age UK pilot sites to explore content and delivery of PCP using a combination of qualitative methods. We will establish an Intervention Development Group to enable iterative intervention optimisation and develop an implementation process for testing and refinement in WP3. We will use the NIH Behaviour Change Consortium framework to enhance intervention fidelity. WP3: Feasibility study We will establish feasibility of a cluster RCT evaluation of PCP for older people with frailty. We will use eFI cutpoints established in WP1 to identify 400 study participants across eight general practices randomised to deliver PCP or usual care. We will: establish recruitment/follow-up rates; feasibility/acceptability of proposed outcome measures; optimise data collection processes; refine the definitive trial sample size calculation. We will assess trial progression criteria at 12 months for: recruitment; intervention delivery; and follow-up. We will continue intervention optimisation in the feasibility study. WP4: Definitive trial Multicentre cluster RCT evaluating clinical and cost-effectiveness of PCP for older people with frailty, identified using the eFI, including health economic evaluation and parallel process evaluation. Outcomes collected at baseline, six and 12 months. Co-primary outcomes: Physical component summary (PCS) and mental component summary (MCS) scores of the SF36 as a measure of health-related quality of life at 12 months. Sample size: 20 general practices per arm, each recruiting 50 patients (2,000 participants in total), will provide 90% power at the 2.5% significance level (overall Type I error=0.05) to detect an MCID of 3 points for PCS and 4 points for MCS.