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The Flourish Index was developed as part of the Human Resources & Services Administration (HRSA) Rural Geriatric Workforce Enhancement Program (GWEP). The goals of our GWEP are to transform clinical training environments with the development and delivery of interdisciplinary geriatric education, infusion of geriatrics into primary care and the training and infusion of community engagement resources to create supportive age-friendly rural environments for older adults. To date, 80 rural older adults with 2 or more chronic diseases have been served by the Flourish Team. We evaluated the impact of the Flourish Model (FM) using the FI to measure improvement in optimal life functioning of rural community-dwelling older adults. The validation study of the FI used baseline data of the 80 patients and evaluated 27 quality of indicators within six determinants of health, namely biological, psychological, individual health behaviors, health services, environmental, and social.
The FM uses community health navigators (CHNs) and community organizers (COs) to connect clinical health care plans with community care plans. CHNs are the overall managers of the interdisciplinary care. COs live in the counties and are knowledgeable about the community health education programs and resources. The CHN performs a detailed geriatric assessment of the specific needs of the patient in managing their chronic conditions.
An interdisciplinary case conceptualization meeting is then held with a geriatrician, pharmacist, social worker, nurse, dentist (when needed), lawyer (when needed), social service worker, CHNs and Cos present. The case conceptualization meeting allows the team to generate new perspectives that facilitate being helpful to patients. The CHN then works closely with the patient and their PCP in the development of a personalized care plan that is executed with support from the whole interdisciplinary team.
The validation study used optimal quantification to treat the multivariate categorical data structure of the FI. Categorical Principal Components Analysis (CATPCA) showed a five-dimensional structure with psychological determinants loading on the biological determinants of health. A bootstrap analysis confirmed the solution was not sample specific. Internal consistency (Cronbach Alpha) for the determinants were as follows: biological/psychological = 0.73, individual = 0.58, environmental = 0.62, health services = 0.65, social determinants = 0.67, and total score = 0.97. Sensitivity to change was shown for the total FI score (F1,22=8.82, p=0.01) and social (F1,22=5.82, p=0.02); with a trend toward sensitivity for individual health behaviors (F1,22=3.95, p=0.06) and health services (F1,22=3.26, p=0.09).
The preliminary analysis of the FI shows promise for the usability of the Index to provide insight into the fundamental challenges of aging. It brings greater clarity in caring for older adults and supports quality evaluation of integrated care coordination models.