title: Embrace, a model for integrated elderly care: study protocol of a randomized controlled trial on the effectiveness regarding patient outcomes, service use, costs, and quality of care.
abstract: BACKGROUND
  Ongoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care.
  
  
  METHODS
  The CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program - combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period.
  
  
  CONCLUSIONS
  This study could provide evidence for the effectiveness of Embrace.
  
  
  BACKGROUND
  The Netherlands National Trial Register NTR3039.
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P,O, BOX 196, 9700 AD, Groningen, The Netherlands. s.l.w.spoorenberg@umcg.nl
authors.forename: Sophie L W
authors.initials: SL
authors.lastname: Spoorenberg
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Uittenbroek
authors.forename: Berrie
authors.initials: B
authors.lastname: Middel
authors.forename: Berry P H
authors.initials: BP
authors.lastname: Kremer
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
authors.forename: Klaske
authors.initials: K
authors.lastname: Wynia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs / Q000592:standards*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D005791:Patient Care / Q000191:economics* / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome