Methods: The FlourishCare team will present data on the effectiveness of the FCM serving 159 older adults with MCCs. We used a two-level longitudinal design and hierarchical linear modeling to test a multilevel growth model where measurement occasions per patient ranged between 2-5. We examined individual differences in FCI scores from baseline to their last measurement occasion and tested potential predictors, modeling a random intercept and slope model.
Results: The sample was mostly female (77%), White (64%), retired (54%), married (30%) or widowed (20%) and living in urban areas (64%). The mean age was 69 (SD=15), with 13 years of education (SD=3). The results show that patients changed significantly over time on total FCI scores (57%-72%;ß=3.80,SE=0.63). In breaking down the determinants, results show significant growth over time for individual health behaviors (58%-67%;ß=2.14,SE=0.84), health care access (71%-89%;ß=4.43,SE=1.00) and social determinants (62%-85%;ß=5.54,SE=1.02) with psychological determinants (54%-61%;ß=1.74,SE=0.95) and environmental determinants (70%-81%;ß=2.81,SE=1.62) showing a trend to significance. Biological determinants only showed significant growth for rural patients (32%-45%;ß=3.46,SE=1.68). Interaction effects with time show that the FCM was able to support patients with lower education attainment to improve at a higher rate than those with higher education attainment, both for the total score on the FCI (ß=-0.59,SE=0.24) and for health care access (ß=-0.94,SE=0.38). Receiving mental health counseling resulted in more improvement in psychological determinants than those who did not receive counseling (ß=3.43,SE=2.04). The FCM was able to support rural patients at a higher rate than urban patients to gain access to health care (ß=4.13,SE=2.02). The FCM supported Hispanic patients the most in improving their social determinants of health (ß=8.40,SE=3.93).
Conclusions: This study showed the importance of a systems approach to care that incorporates a whole health approach using measures that focus on what matters most to patients, especially for older adults who place importance on quality-of-life outcomes. Furthermore, the study showed how a whole health approach to care can address equality by accelerating the flourishing of rural, Hispanic patients with lower educational attainment, promoting social and racial justice.