Community Assessment of Risk Tool and Strategies Programme (CARTS)
The CARTS Programme is a risk intervention strategy developed by researchers at the Centre for Gerontology and Rehabilitation in University College Cork. This innovative programme is a key initiative in the COLLAGE EIP on AHA Reference Site application. CARTS aims to identify, quantify, stratify and manage risk of adverse outcomes (AO) among community dwelling, older adults. It represents a paradigm shift in clinical assessment, going beyond the traditional assessment process, merging the concepts of rapid screening instruments with single assessment tools. It identifies and assesses each individual patient’s problems, the ability of their caregiver network to manage the problems and describes gaps or deficiencies in care. Established, cost effective, evidence based strategies are then used to reduce the risk of AO, allowing care pathways or bundles tailored to the individual’s needs, to emerge . Once the strategies have been put in place, the patient is reassessed to determine the effectiveness of these various interventions. Through this holistic process, CARTS delivers comprehensive screening, triage, assessment and treatment with the aim of increasing functional independence, improving quality of life, delaying and/or preventing disability, and optimizing the use of scarce resources in a reliable, valid and evidence based way.
Pilot study data will inform the scale up to a large RCT of the complete CARTS programme in 5000 subjects in the Cork/Kerry region. PHNs will be trained using a “train the trainer” approach.
The Health Service Executive of Ireland has funded the pilot study to date and an additional funding application has been made to extend the study regionally.
Prof William Molloy : firstname.lastname@example.org
Dr Rónán O’Caoimh : Rocaoimh@hotmail.com
Dr Yvonne Clune : email@example.com
Individual and small group workshops involving doctors, nurses and allied health professionals (AHPs), social care workers etc… were carried out to develop and test the CART screening tool. A training package was designed and inter-rater reliability was determined before (60-70%) and after (95%) training. A pilot study is on going whereby twenty community or public health nurses (PHNs) trained to administer the CART assessed 803 community dwelling older adults at baseline, 6 and 12 months. Preliminary results show that those at high risk are 30 times more likely to be hospitalised, institutionalised or die in the following six months compared to those in the low risk group. Twelve-month assessment will take place in March/April 2013. A pilot intervention phase will then commence with high and intermediate risk individuals being randomised to receive either a comprehensive geriatric assessment and targeted interventions or “normal care”. The aim is to identify strategies to reduce risk and prevent AOs. We are collaborating with other EIP AHA members to design a multi-centre randomised controlled trial (RCT) and plan to apply for funding in Horizon 2020. The CART tool is also being used an outcome measure as part of two FP-7 (ICT call 2013) grant proposals PERSSILLA and VitalExerCoach in conjunction with other partners in the EU including two reference site bids within Action Group A3 of the EIP on AHA (Municipality of Enschede, Netherlands and Campania Region, Italy).