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- Title
FlourishCare Model of Integrated Care: The Validation of the Flourish Index—Revised.
- Authors
Faul, Anna C; D'Ambrosio, Joseph G; Cotton, Samantha G; Dobson, Molly M; Furman, Christian D; Gordon, Barbara A; Linzy, Katherine E; Yankeelov, Pamela A
- Abstract
Background and Objectives This study validates the Flourish Index–Revised (FI-R), a tool evaluating integrated healthcare models. The original Flourish Index (FI) was developed in 2018 and has been refined to align with the FlourishCare (FC) Model (Model) for geriatric primary care. Research Design and Methods The Model provides integrated biopsychosocial healthcare to older adults. The FI-R uses 25 quality-of-care indicators and 7 contextual community indicators. The FI-R was validated with Categorial Principal Components Analysis (CATPCA) using a sample of 949 patients 50+ who were mostly female (73%), non-Hispanic White (70%), living in urban areas (90%), and married (29%), single (22%), or divorced (19%). The mean age was 73.46 (standard deviation [ SD ] = 10.86) and mean years of education was 14.30 (SD = 2.14). Results CATPCA showed a 4-dimensional structure of biological, psychological, and 2 social determinants of health (SDOH) subdomains: health behaviors and community. Final selection of indicators was based on total variance accounted for >0.30, absolute values of item loadings >0.45, and not having cross-loadings >0.45 on 2 factors. Internal consistency (Cronbach's alpha) for the determinants were biological = 0.75, psychological = 0.76, SDOH:community = 0.70, SDOH:health behaviors = 0.50, and total FI-R = 0.95. Sensitivity to change was shown for the total FI-R, psychological determinants, and SDOH:health behaviors, but not for biological determinants. Discussion and Implications The validation of the FI-R shows promise for its usability to evaluate integrated healthcare models using existing measures in electronic health systems. More work is needed to improve the incorporation of SDOH:sociodemographics into the FI-R.
- Subjects
ELDER care; CLINICAL medicine; COMMUNITY health services; SOCIAL determinants of health; INTERPROFESSIONAL relations; STATISTICAL significance; RESEARCH funding; PRIMARY health care; QUESTIONNAIRES; RESEARCH methodology evaluation; RESEARCH evaluation; KEY performance indicators (Management); DESCRIPTIVE statistics; MATHEMATICAL models; RESEARCH methodology; RESEARCH; HEALTH behavior; PSYCHOMETRICS; THEORY; FACTOR analysis; DATA analysis software; INTEGRATED health care delivery; MEDICAL referrals; EVALUATION
- Publication
Gerontologist, 2024, Vol 64, Issue 7, p1
- ISSN
0016-9013
- Publication type
Article
- DOI
10.1093/geront/gnae042