Regional implementation of a new medical care model in residential homes for the elderly to improve quality of care.

Background:

Residents of Dutch residential homes for the elderly have become progressively older and more care dependant while staff has become fewer in numbers and lower in training level. The medical care is provided by several general practitioners without specific training for this complicated group of patients. Various best practices have shown the advantages of a new medical care model, which is based on closer cooperation between the care providers, a more proactive approach and using multidisciplinary care plans. Nevertheless, broad implementation has not been achieved in the Netherlands yet.



Objectives:

Regional implementation of a new medical care model in 40 residential homes. Monitoring of care quality outcomes, satisfaction of patients, family and care providers and the progress of the implementation strategy.



Methods:

Within the new care model, local working groups are started in each residential home consisting of at least General Practitioners, elderly care physicians and the nursing staff team leaders. Every working group defines its own goals for improvement of the care and is supported by coaching and education. Funding has will be sought within the confines of the present system.

Implementation will be performed according to a well considered strategy whereby all relevant parties are actively consulted and involved. Monitoring is performed by interviewing the residents and their informal care provider using validated instruments and by questioning the professional care providers at baseline and after 12 and 24 months. The implementation process will be described and evaluated constantly.



This project will generate and improve knowledge about the implementation of a new model of medical care in residential homes for the elderly.

Ameliorate the quality of medical care for older persons living in residential homes for the elderly by implementing a new care model for medical care in the homes for the elderly.

Baseline, 12 months, 24 months.

Implementation of a new care model (proactive and integrated care for the elderly, using multidisciplinary care plans):

1. Step 1: Interest the home for the elderly in participation in the project (target group = home for the elderly);

2. Step 2: Implementation of the new care model (target group = GP's);

3. Step 3: Change to the preferent GP (target group = residents);

4. Step 4: Execution of quality modules (target group = whole system).



Per step the phases orientation, get insight, acceptation, changing, were followed.



MOVIT achieves a working group per residential home who define their own level of ambition and improvement targets. They receive organizational support and training from MOVIT. MOVIT computes the satisfaction and effects on quality of care in all concerned parties. Questionnaires and interviews are used for measurements.