Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview
Complex interventions are criticized for being a “black box”, which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically u...
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Published in | Journal of clinical epidemiology Vol. 96; pp. 110 - 119 |
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Main Authors | , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.04.2018
Elsevier Limited |
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Abstract | Complex interventions are criticized for being a “black box”, which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions.
A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands.
There was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists.
An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions. |
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AbstractList | ObjectivesComplex interventions are criticized for being a “black box”, which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions.Study Design and SettingA systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands.ResultsThere was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists.ConclusionsAn in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions. Complex interventions are criticized for being a "black box", which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions. A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands. There was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists. An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions. |
Author | Ruikes, Franca G.H. Muntinga, Maaike E. Metzelthin, Silke F. Gussekloo, Jacobijn Blom, Jeanet W. Wynia, Klaske Koopmans, Raymond Jansen, Aaltje P.D. Melis, Rene J.F. Schuurmans, Marieke J. Spoorenberg, Sophie L.W. Kempen, Gertrudis I.J.M. Smit, Linda C. Bleijenberg, Nienke Suijker, Jacqueline J. De Wit, Niek J. Looman, Willemijn M. Fabbricotti, Isabelle N. Moll van Charante, Eric P. |
Author_xml | – sequence: 1 givenname: Linda C. surname: Smit fullname: Smit, Linda C. email: Linda.Smit@hu.nl organization: Research Group for the Chronically Ill and Elderly, Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht 3584 CS, The Netherlands – sequence: 2 givenname: Marieke J. surname: Schuurmans fullname: Schuurmans, Marieke J. organization: Research Group for the Chronically Ill and Elderly, Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht 3584 CS, The Netherlands – sequence: 3 givenname: Jeanet W. surname: Blom fullname: Blom, Jeanet W. organization: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands – sequence: 4 givenname: Isabelle N. surname: Fabbricotti fullname: Fabbricotti, Isabelle N. organization: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam 3062 PA, The Netherlands – sequence: 5 givenname: Aaltje P.D. surname: Jansen fullname: Jansen, Aaltje P.D. organization: Department of General Practice and Elderly Care, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, 1081 BT, The Netherlands – sequence: 6 givenname: Gertrudis I.J.M. surname: Kempen fullname: Kempen, Gertrudis I.J.M. organization: Department of Health Services Research, and Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht 6229 GT, The Netherlands – sequence: 7 givenname: Raymond surname: Koopmans fullname: Koopmans, Raymond organization: Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen C500 HB, The Netherlands – sequence: 8 givenname: Willemijn M. surname: Looman fullname: Looman, Willemijn M. organization: Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen 6500 HB, The Netherlands – sequence: 9 givenname: Rene J.F. surname: Melis fullname: Melis, Rene J.F. organization: Department of General Practice, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands – sequence: 10 givenname: Silke F. surname: Metzelthin fullname: Metzelthin, Silke F. organization: Department of Health Services Research, and Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht 6229 GT, The Netherlands – sequence: 11 givenname: Eric P. surname: Moll van Charante fullname: Moll van Charante, Eric P. organization: Department of General Practice, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands – sequence: 12 givenname: Maaike E. surname: Muntinga fullname: Muntinga, Maaike E. organization: Department of General Practice and Elderly Care, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, 1081 BT, The Netherlands – sequence: 13 givenname: Franca G.H. surname: Ruikes fullname: Ruikes, Franca G.H. organization: Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre Nijmegen, Nijmegen C500 HB, The Netherlands – sequence: 14 givenname: Sophie L.W. surname: Spoorenberg fullname: Spoorenberg, Sophie L.W. organization: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen 9700 AD, The Netherlands – sequence: 15 givenname: Jacqueline J. surname: Suijker fullname: Suijker, Jacqueline J. organization: Department of General Practice, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands – sequence: 16 givenname: Klaske surname: Wynia fullname: Wynia, Klaske organization: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen 9700 AD, The Netherlands – sequence: 17 givenname: Jacobijn surname: Gussekloo fullname: Gussekloo, Jacobijn organization: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden 2333 ZD, The Netherlands – sequence: 18 givenname: Niek J. surname: De Wit fullname: De Wit, Niek J. organization: Department of General Practice, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands – sequence: 19 givenname: Nienke surname: Bleijenberg fullname: Bleijenberg, Nienke organization: Research Group for the Chronically Ill and Elderly, Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht 3584 CS, The Netherlands |
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Copyright | 2018 The Authors Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved. Copyright Elsevier Science Ltd. Apr 1, 2018 |
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Keywords | Development Evaluation Improvement Systematic overview Primary-care programs Complex interventions |
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SubjectTerms | Adults Black boxes Complex interventions Development Epidemiology Evaluation Fidelity Frailty Improvement Medicaid Modelling Older people Primary-care programs Studies Systematic overview Training |
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Title | Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview |
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