title: Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial.
abstract: BACKGROUND
  Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of community-dwelling frail older adults.
  
  
  METHODS
  A 24-month stepped wedge cluster randomized controlled trial was conducted between May 2010 and March 2013 in 35 primary care practices in the Netherlands, and included 1147 frail older adults. The intervention consisted of a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Reassessment occurred every six months. Nurses worked together with primary care physicians and were supervised and trained by geriatric expert teams. Complex patients were reviewed in multidisciplinary consultations. The primary outcome was quality of life (SF-12). Secondary outcomes were health-related quality of life, functional limitations, self-rated health, psychological wellbeing, social functioning and hospitalizations.
  
  
  RESULTS
  Intention-to-treat analyses based on multilevel modeling showed no significant differences between the intervention group and usual care regarding SF-12 and most secondary outcomes. Only for IADL limitations we found a small intervention effect in patients who received the intervention for 18months (B=-0.25, 95%CI=-0.43 to -0.06, p=0.007), but this effect was not statistically significant after correction for multiple comparisons.
  
  
  CONCLUSIONS
  The GCM did not show beneficial effects on quality of life in frail older adults in primary care, compared to usual care. This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population.
  
  
  BACKGROUND
  The Netherlands National Trial Register NTR2160.
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, France; Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: e.hoogendijk@vumc.nl.
authors.forename: Emiel O
authors.initials: EO
authors.lastname: Hoogendijk
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: he.vanderhorst@vumc.nl.
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.affiliation: Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: p.vandeven@vumc.nl.
authors.forename: Peter M
authors.initials: PM
authors.lastname: van de Ven
authors.affiliation: Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: jwr.twisk@vumc.nl.
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.affiliation: Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: djh.deeg@vumc.nl.
authors.forename: Dorly J H
authors.initials: DJ
authors.lastname: Deeg
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: d.frijters@vumc.nl.
authors.forename: Dinnus H M
authors.initials: DH
authors.lastname: Frijters
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Health Sciences, EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University, Amsterdam, The Netherlands. Electronic address: k.m.vanleeuwen@vu.nl.
authors.forename: Karen M
authors.initials: KM
authors.lastname: van Leeuwen
authors.affiliation: Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. Electronic address: jos.vancampen@slz.nl.
authors.forename: Jos P C M
authors.initials: JP
authors.lastname: van Campen
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: g.nijpels@vumc.nl.
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: d.jansen@vumc.nl.
authors.forename: Aaltje P D
authors.initials: AP
authors.lastname: Jansen
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: hpj.vanhout@vumc.nl.
authors.forename: Hein P J
authors.initials: HP
authors.lastname: van Hout
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D005853:Geriatrics / Q000379:methods / Q000458:organization & administration*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D057187:Independent Living; D008297:Male; D008603:Mental Health; D009426:Netherlands; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D011788:Quality of Life; D012919:Social Behavior
keywords: Comprehensive care program; Frail elderly; Geriatric assessment; Primary care