Value-Based Benefits and Quality of Life of Incorporating Multidomain Interventions into Integrated Primary Care: A Randomized Controlled Trial

Background: Hypothetically, incorporating multidomain interventions into primary healthcare might improve standard value-based health outcomes. Methods: The Taiwan Integrated Geriatric Care study recruited community-dwelling ≥65-year-olds with ≥3 chronic conditions, excluding people receiving cancer therapy, with life expectancy <12 months, or with insufficient communication ability. Participants were randomized 1:1 to usual care versus an integrated multidomain intervention, which entailed 16, 2 h sessions/year comprising communal physical exercise, cognitive training, nutrition and disease education, plus individualized treatment by specialists in integrated geriatric care. The primary outcomes were 36-item Short Form Health Survey (SF-36) quality of life scores. International Consortium for Health Outcomes Measurement Standard Set Older Person metrics were secondary outcomes, and Montreal Cognitive Assessment was an exploratory outcome. Intervention effects were analyzed with a generalized linear mixed model. Findings: From 25 June 2018 until 14 March 2020, 398/638 screened participants were assigned to integrated multidomain intervention (n=199) versus usual care (n=199); 335 (84.2%) completed the study. Compared with usual care recipients, integrated multidomain participants had significantly higher SF-36 physical component scores (0.8, 95% CI 0.2–1.5), were more likely to complete advance care planning (OR 1.40, 95% CI 1.04–1.88), and had lesser likelihoods of limited instrumental activities of daily living (OR 0.7, 95% CI 0.6–0.9), pain (OR 0.6, 95% CI 0.4–0.9), slowness (OR 0.81, 95% CI 0.66–1.00), and cognitive impairment (OR 0.5, 95% CI 0.4–0.7). Interpretation: Incorporating multidomain interventions into integrated healthcare increased quality of life and improved value-based health outcomes and cognitive performance. Trial Registration: TIGER was registered prospectively at ClincalTrials.gov, NCT03528005. Funding Statement: The National Health Research Institutes, Taiwan and the Ministry of Science and Technology, Taiwan. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The institutional review boards of National Yang-Ming University (YM107042F), Taipei Veterans General Hospital (2018-05-002CC), Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation (IRB 107- 90-B), and National Yang-Ming University Hospital (2018A023) approved the protocol.