Co-management for in-hospital geriatric patients: development and evaluation of its process, structure and outcomes
This PhD project will focus on the development and evaluation of a team-based co-management intervention for geriatric patients hospitalized on a non-geriatric hospital unit. The primary aim of this intervention will be to prevent functional decline as a result of hospital admission. For this, the Medical Research Council framework for the development and evaluation of complex interventions will be used. First, a systematic review will evaluate the effect of geriatric in-hospital co-management interventions on functional status and will identify key process, structure and outcomes indicators associated with geriatric co-management. Next, identified indicators will be rated by international geriatric co-management experts in a two-round Delphi study for their appropriateness and feasibility to use for the evaluation of a team-based co-management intervention for geriatric patients admitted to the hospital, and if implemented will be considered likely to improve patient care and outcomes. Based on these results and insights from other published literature, a conceptual co-management model for geriatric patients admitted on a non-geriatric unit will be developed, linking evidence-based interventions to key processes, structures, and outcomes based on an understanding of the causal mechanisms and pathways of functional decline. A controlled before and after study will evaluate the developed co-management model on cardiology and cardiac surgery wards. The primary outcome will be functional status at discharge and one, three and six months post discharge. Secondary outcomes will be mortality, cognition, length of stay, iatrogenic complications, health-related quality of life, quality-adjusted life years and change on risk factors status. A process evaluation will determine the dose, fidelity and reach of the intervention. Participants’ experiences will be measured using focus groups and semi-structured interviews focusing on barriers, facilitators, acceptability and feasibility as experienced by intervention participants.