title: Development of a proactive care program (U-CARE) to preserve physical functioning of frail older people in primary care.
abstract: OBJECTIVE
  Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in detail the development process of the U-CARE program to allow its replication.
  
  
  METHODS
  The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a theoretical guide for the design of the U-CARE program. An extended stepwise multimethod procedure was used to develop U-CARE. A team of researchers, general practitioners, registered practice nurses, experts, and an independent panel of older persons was involved in the development process to increase its feasibility in clinical practice. A systematic review of the literature and of relevant guidelines, combined with clinical practice experience and expert opinion, was used for the development of the intervention.
  
  
  RESULTS
  Based on predefined potentially effective guiding components, the U-CARE program comprises three steps: a frailty assessment, a comprehensive geriatric assessment at home followed by a tailor-made care plan, and multiple follow-up visits. Evidence-based care plans were developed for 11 geriatric conditions. The feasibility in clinical practice was tested and approved by experienced registered practice nurses.
  
  
  CONCLUSIONS
  Using the MRC Framework, a detailed description of the development process of the innovative U-CARE program is provided, which is often missing in reports of complex intervention trials. Based on our feasibility-pilot study, the general practitioners and the registered practice nurses indicated that the U-CARE intervention is feasible in clinical practice.
  The U-CARE program consists of promising components and has the potential to improve the care of older patients.
authors.affiliation: Rho Chi at Large, Nurse, Nursing Scientist, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Nienke
authors.initials: N
authors.lastname: Bleijenberg
authors.forename: Valerie H
authors.initials: VH
authors.lastname: ten Dam
authors.forename: Irene
authors.initials: I
authors.lastname: Drubbel
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005240:Feasibility Studies; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000458:organization & administration*; D006801:Humans; D015403:Nursing Evaluation Research; D010865:Pilot Projects; D059017:Primary Care Nursing; D016730:Program Development
keywords: Frailty; comprehensive geriatric assessment; nurse; older people; primary care