FlourishCare Model of Integrated Care: The Validation of the Flourish Index-Revised

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. The Model provides integrated biopsychosoc...

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Bibliographic Details
Published in:	The Gerontologist Vol. 64; no. 7
Main 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
Format:	Journal Article
Language:	English
Published:	United States Oxford University Press 01-07-2024
Subjects:	Aged Aged, 80 and over Delivery of Health Care, Integrated Female Humans Male Measurement Middle Aged Primary Health Care Principal Component Analysis Quality Indicators, Health Care Reproducibility of Results Age-friendly healthcare Biopsychosocial determinants of health Integrated healthcare Interprofessional teams Analysis—categorical analysis
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Summary:	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. 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). 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0016-9013 1758-5341 1758-5341
DOI:	10.1093/geront/gnae042