Abstract

Background: Person-centered care management based on comprehensive needs assessment is widely known as an effective way to promote quality and outcomes of care for frail older adults. Yet such evidence is still limited for older people in nursing homes, especially in Asia. We developed the Systems for Person-Centered Elder Care (SPEC) Model, a technology-enhanced, multidisciplinary, integrated care management model tailored for nursing homes serving public long-term care insurance beneficiaries in South Korea.

Objectives: Along with the context of long-term care delivery, we will introduce the ICT-enhanced SPEC model and present the effectiveness and acceptance of the model.

Methods: Guided by the Chronic Care Model, the multifaceted SPEC consists of key five elements: comprehensive geriatric assessment and need/risk profiling using interRAI LTCF and other assessment tools; individualized, need-based care planning; optional multidisciplinary case conference meetings; coordination of care; and information and communication. We conducted a randomized controlled trial using a stepped-wedged design in ten nursing homes. About 450 participants and 150 employees participated in the study. In each home, the intervention took about 10 months including a pre-observation period. The primary outcome measure was a risk-adjusted composite quality indicator (QI), and key secondary measures were 15 individual QIs. The acceptance of the new technology for care management by system users (providers) was also evaluated.

Results: During the first three months, the composite QI score was significantly improved by about 10 percentage points, and several individual QIs were improved in the areas of declines in activities of daily living and cognition. The users of the newly introduced prototype ICT system for the study reported high usefulness but relatively low ease of use for the system.

Conclusions: This study provides evidence for the feasibility and effectiveness of an ICT-enhanced care management model in nursing homes with limited staffing and resources in Korea. Research and policy implications of the study for international audiences will be discussed based on the findings.