Community-based person-centred integrated care (PIC) networks for healthy ageing in place: a scoping review protocol

Identify the research question

As outlined in the Introduction, this study was motivated by a review of the previous EPICS model of PIC for older people that operated in the UK during the 1990s. In developing the EPICS model for the 21st century context, we will draw on lessons learnt from any similar models implemented elsewhere. The number, characteristics and evidence base for community-based care networks similar to EPICS are currently unknown. Therefore, we will undertake a scoping review to answer this research question: What practice-based models of PIC networks exist at the local/neighbourhood level to support the health and well-being of older people and what evidence is available as to their effectiveness for healthy ageing in place?

The following subquestions will inform data extraction from selected studies to answer the primary research question:

• What are the aims and anticipated outcomes of existing PIC network models?

• What are the core components of existing PIC network models?

• To what extent has each PIC network model been evaluated for its effectiveness in achieving anticipated outcomes?

Identify the relevant studies

An initial search strategy was developed using the MEDLINE/PubMed and Web of Science databases, which together offer broad coverage of peer-reviewed studies across medical and social sciences. Preliminary internet searches were also conducted using Google, to explore the availability of non-peer-reviewed material (‘grey literature’, eg, reports, policy papers, unpublished papers or theses). Within PubMed, an initial search of key terms ‘integrated care’ yielded 8173 results, and ‘care network’ yielded 3545 results. Following the JBI PCC framework, an initial search protocol that included terms for older people (Population), integrated care network models (Concept) and community-based support for healthy ageing in place (Context) yielded 543 results from PubMed and Web of Science databases after removal of duplicates. In line with JBI guidance,24 the titles and keywords of these studies were analysed using NVivo software (V.12) to identify any recurring concepts or equivalent terms not already included in the search protocol. Following this analysis, the search protocol was expanded to include the proposed terms listed in table 1.

This search protocol will be applied to a range of appropriate databases to ensure broad coverage across a full spectrum of academic fields, with no restrictions in language or publication dates. In addition to MEDLINE/PubMed and Web of Science, searches will be run in Abstracts of Social Gerontology (ageing), ASSIA (applied social sciences), CINAHL (nursing and allied health), Scopus (science, medicine and some social science) and PsycINFO (psychological, social and behavioural sciences).

Identified sources from all databases will be collated into a reference management system for the removal of duplicate references. Grey literature will be identified by screening a selection of results from Google (using combinations of search terms from table 1) in order of relevance, and by searching websites of policy and voluntary sector organisations focused on integrated care and/or healthy ageing. Relevant organisations include the WHO, Centre for Policy on Ageing, Centre for Ageing Better, Age UK, UK Department for Health and Social Care, The Kings Fund, EngAgeNet, The Health Foundation and the International Foundation for Integrated Care.

Study selection

The criteria shown in table 2 will be applied independently by two researchers to select relevant studies. The target population of ‘older people’ will generally refer to people aged 60 years or older, as defined by the United Nations and in line with usage of the term in England’s National Health Service; however, the ambiguity of the term is acknowledged, and some flexibility on age cut-off may be applied for studies that report on support networks for conditions associated with older age (eg, frailty), even if some study participants are under 60. Initial screening will be limited to title and abstract, with a selection of sources reviewed by both researchers to check for consistent application of inclusion criteria. Sources retained after this stage will then undergo full-text review, and reasons for study exclusion will be recorded. Any disagreements will be resolved through discussion, with a third researcher arbitrating as needed. After full screening, reference lists of included studies will be reviewed to identify any further relevant sources. In line with the exploratory nature of a scoping review, any studies meeting the inclusion criteria will contribute to data extraction and analysis, irrespective of methodological quality. Any quality limitations of included studies will be reported in the review article.

Charting the data

Data will be extracted from each selected study onto a template containing the following fields: author names, publication year, source (eg, journal name and volume number), study design and methodology, name or description of network model, year that the model was first implemented and year stopped (if applicable), geographic setting, aims and anticipated outcomes of network model, targeted population, financial structure of network, management structure of network, network components (ie, services provided, mechanisms for service coordination) and evidence of evaluation. Data extraction will be conducted independently by two researchers for the first 10% of selected studies to ensure consistency of approach, with review and arbitration by a third researcher as needed. Thereafter data extraction will be done by one researcher per study, with regular research team meetings to share emergent findings and to discuss any queries raised.

Collating, summarising and reporting the results

A PRISMA flow diagram (figure 1) will be presented to show the number of sources screened and the reasons for study exclusion, in order to arrive at the final set of sources for the review. To describe the extent and range of evidence of community-based PIC network models, summary tables of included sources will be presented; these will be adapted from the data extraction template in order to address the main research question and its subquestions. Comparisons across studies of key components (eg, holistic assessment, case management, social prescribing and voluntary sector support) will be presented narratively, in order to highlight common aspects or points of divergence in how PIC network models are implemented across geographic settings. While scoping reviews do not involve a formal Risk of Bias assessment or meta-synthesis analysis, we will provide a narrative summary of the methodological quality of included studies, to both highlight any limitations in the available evidence and to identify any high-quality evaluations of PIC network models that could be the focus of detailed further analysis.

Figure 1

PRISMA flow diagram for scoping review process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Patient and public involvement

No members of the public were directly involved in the development of the scoping review protocol. However, the overall research focus was informed by public and stakeholder involvement to develop the concept of PIC networks from the previous EPICS model. A workshop held in January 2023 brought together stakeholders from the voluntary sector, local government organisations, care service providers, older people’s advocacy organisations and researchers from multiple academic disciplines on healthy ageing to share knowledge of care practices and service coordination from multiple geographical contexts. Feedback on experiences, challenges and opportunities for locally based support for healthy ageing was collected through engagement with a local organisation run by and for older people in February 2023. Public engagement continued through the summer and autumn of 2023 to prompt ongoing feedback on challenges and opportunities for developing local PIC networks, via meetings at local community centres and a larger-scale event at the town hall. The research team maintains links with these stakeholders and public representatives, who will be invited to form an advisory board as the main review is conducted.

Summary, ethics and dissemination

Now that PIC is a firmly established tenet of the UK’s NHS, revisiting the principles of the EPICS model and considering how they might be applied in the current demographic and economic climate is timely. In particular, an updated model should consider opportunities for intergenerational engagement20 and the role of digital infrastructure in supporting healthy ageing. Interaction between the generations improves well-being and mental health for both young and old, and intergenerational living can help address loneliness through conducive spaces designed to encourage regular interaction; intergenerational communities have the opportunity to provide an effective social service and support network for residents of all ages. An effective digital infrastructure can facilitate coordinated care planning and should enable local support networks to be integrated with community-oriented primary care, with proactive preventative interventions that aim to improve population health and health equity.

The proposed scoping review will address knowledge gaps on how existing services and supports may be configured as operational networks for supporting healthy ageing in place, drawing on the principles of an updated EPICS model. In identifying a range of PIC Network case examples and any evidence demonstrating their effectiveness, we will better understand how older people can be supported to live well in their communities for as long as possible. If enough PIC network models with a sufficient evidence base are identified, further work could include a systematic review of the effectiveness of PIC networks for delaying transition to high-intensity long-term care, in order to identify the most promising models for adaption and implementation at scale.

As no new data will be collected from older people during this study, ethical approval is not required to conduct this scoping review. However, it is our intention that the findings of this review will inform a follow-up project on the implementation of PIC networks in specific settings. In addition to publication as a peer-reviewed article, the results of this review will be summarised as shorter discussion papers to prompt new data collection through a series of citizen and stakeholder workshops on PIC network implementation. Ethical approval will be sought separately for this anticipated follow-up research. In the event of protocol amendments, the date of each amendment will be documented and accompanied by a description of any changes and the rationale.