JMIR Publications

ABSTRACT

Background:

Integrated care facilitated by Information and Communication Technology offers a promising approach to actively responding to the global older care burden. However, its effectiveness remains unclear.

Objective:

This study aimed to evaluate the effectiveness of an intelligent and integrated older care model (SMART system) in improving the quality of life for older people living at home.

Methods:

A randomized controlled trial was conducted. After assessing eligibility, participants were randomly allocated in a 1:1 ratio to receive the personalized integrated care delivered by the SMART system or usual care for 3 months from November 1, 2020, to December 31, 2020. The primary endpoint was the percent change in quality of life from baseline to the 3-month follow-up, while secondary endpoints included functional status and percent changes in health self-management ability, social support, and confidence in avoiding falling of older individuals from baseline to the 3-month follow-up. All data analysis followed the intention-to-treat principle. A covariance model or logistic regression model was performed to estimate the effectiveness as appropriate. Subgroup and sensitivity analyses were also conducted to verify the robustness of our findings.

Results:

Of 94 participants included, 48 were assigned to the SMART Group. The SMART system demonstrated a statistically significant improvement in quality of life among home-dwelling older participants, with an estimated intervention difference of 11.97% (95% CI: 7.20%-16.74%, p<0.001). Similarly, it substantially enhanced health self-management ability and social support compared to the usual care (difference: 4.95%, p<0.05; difference: 6.75%, p<0.001). Furthermore, the SMART system significantly reduced instrumental activities of daily living (IADL) disability (OR: 0.34, 95%CI: 0.11-0.83, p=0.024), while no statistically significant reduction in activities of daily living (ADL) disability was observed. The subgroup and sensitivity analyses yielded identical results.

Conclusions:

Personalized and integrated care provided via the SMART system significantly improved quality of life, health self-management ability, and social support among older individuals, while also reducing IADL disability. Clinical Trial: This study was prospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR-IOR-17010368) on 12/01/2017.