HUMAN FLOURISHING AS AN OUTCOME OF INTEGRATED PRIMARY CARE AND COMMUNITY BASED MODELS OF CARE

Abstract

BACKGROUND: Integrated primary care (PC) and community-based models of care have potential to improve outcomes in frail older adults. Traditional outcome measures focusing on reducing hospitalizations and ER visits, and improving disease management, diminish models that focus on the determinants of health promoted by the CDC: biological, individual health behaviors, environmental, health services, psychological, and social. We evaluated the impact of the Flourish Model (FM), using a Flourish Index to measure improvement in optimal life functioning of rural community-dwelling frail older adults. METHOD(S): A repeated measures design was used to evaluate FM in 6 rural counties, serving 5 PC practices, and using community health navigators (CHNs) and community organizers to connect health care plans with community care plans. The intervention consisted of a geriatric and environmental assessment completed in the home of the patient, followed by an interdisciplinary case conceptualization meeting where the care plan was designed. The CHN supported the patient in the implementation of the plan and connected them to community resources. The primary outcome was improvement on the Flourish Index that investigated 33 indicators of optimal life functioning, within the limitations of frailty, and framed within the 6 determinants of health. RESULT(S): The 25 patients had a mean age of 76 and were mostly White females. The majority earned < $1,500 monthly. Nearly half of the patients didn't have a HS diploma. The most prominent chronic conditions were diabetes, high blood pressure, heart disease, arthritis, dementia, and depression. A repeated measures MANOVA showed significant main effects for time (baseline vs. six months) on improvement in Flourish indicators (F(6,19)=46.9, p=.001, eta2=.85), specifically biological (F(1)=139.6, p=.001, eta2=.97), environmental (F(1)=12.1, p=.002, eta2=.34), health services (F(1)=45.8, p=.001, eta2=.66), and social (F(1)=102.5, p=.001, eta2=.81). Individual health behaviors showed a trend (F(1)=3.5, p=.07, eta2=.13). Psychological determinants did not show a significant change. CONCLUSION(S): The FM showed promising results for frail older adults living in rural areas. The study challenges the limited perspective of traditional health outcome measures and strengthens the need for a holistic approach to integrated care and outcome measurement where all determinants of health are addressed.