Comprehensive evaluation of ICOPE pilot project in China using Multi-Criteria Decision Analysis (MCDA): a study design

Introduction: Performing a comprehensive evaluation of integrated care constitutes a challenge to measure the quality, efficiency and sustainability of both integrated programs and usual care in the transition toward a continuous health care system. In China, the WHO Integrated Care for Older People (ICOPE) pilot project has been implemented since 2020 to address the issue of care fragmentation by providing integrated services for elderly adults based on their intrinsic capacity and functional ability. In 2022, the ICOPE China Phase II Pilot launched at a broader level. Context: The ICOPE China Phase II Pilot will use a quasi-experimental study design. In each pilot area, 1500 community residents aged 65 and over at risk of functional decline will be selected through primary screening and randomized into intervention and control groups with a 1:2 ratio. In addition to health education and regular follow-ups for both two groups, the intervention group receives individual care plans based on the ICOPE pathway implemented by the integrated care team, including rehabilitation care, nutritional management, remote consultation, home environment modification and professional guidance for caregivers. Aims: In the evaluation of an integrated care project, it’s often hard to achieve a comprehensive vision or assess the value of integration. The Multi-Criteria Decision Analysis (MCDA) method can provide a framework considering multiple perspectives and different preferences of stakeholders with sensitive analysis, allowing a standardized comparison of outcomes between the intervention group (integrated care) and control group (usual care). This study applies MCDA to the evaluation of the ICOPE China Phase II Pilot, to assess the comprehensive effect and outcome of integration. Methods: The evaluation will be carried out in three steps: Firstly, the evaluation framework will be formulated by document analysis and interviews with stakeholders and experts, from which the outcome indicators including ADL, mental and nutritional status, experience of care, caregiver burden and resource utilization are screened. Secondly, the relative weights of outcomes involved in the MCDA will be obtained from the Discrete Choice Experiment (DCE) among stakeholder groups as well as the Swing Weighting Method conducted by the same expert group of indicator screening. Performance scores will be standardized and multiplied by their weights of importance to obtain the overall MCDA value. Thirdly, the result of the intervention and control group will be comprehensively analyzed to assess the effectiveness of the integrated care program in the pilot area. At the same time, a sensitivity analysis of the scoring results will be executed to distinguish the uncertainties in the decision-making process.Conclusions: The application of MCDA in the evaluation of the ICOPE pilot project will broaden the scope of the evaluation and provide an empirical basis for the implementation of the integrated care project in China.