Urban Chinese community-dwelling older adults’ expectations regarding the delivery of integrated care through case managers: protocol for a mixed methods study

Background: The rising burden of chronic diseases among older adults in China underscores the urgent need for an integrated and efficient health care system. Existing services are often fragmented, lacking coordination and accessibility, particularly for urban community-dwelling older adults with multiple comorbidities. There is a critical demand for person-centered integrated care that enables resource sharing, expert guidance, and the safe, continuous management of chronic conditions. Objective: This study aims to extend the theoretical understanding of case-managed integrated care informed by the Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) model within urban Chinese communities. It will examine older adults’ expectations for case-managed integrated care, develop and validate a measurement instrument to quantify these expectations, and build an evidence-based framework to adapt the PRISMA model to the Chinese context. Methods: An exploratory sequential mixed methods design will be used across 3 phases. Phase I involves qualitative interviews with community-dwelling older adults and other stakeholders to explore unmet health care needs and perceptions of case-managed integrated care. Phase II entails the development and psychometric validation of a questionnaire informed by the findings from phase I. Phase III involves a large-scale cross-sectional survey in Wenzhou, Taiyuan, and Hainan to quantify expectations for case-managed integrated care and identify associated sociodemographic factors. A data integration approach will be used to synthesize both qualitative and quantitative findings, providing a comprehensive understanding of expectations regarding the proposed integrated care. Results: Data collection is scheduled to begin in December 2025, with the study expected to last 24 months. Ethics approval has been obtained from the Institutional Ethics Committee. Conclusions: This study seeks to evaluate the feasibility of culturally adapting the PRISMA model for case-managed integrated care to address critical gaps in existing health care service delivery. The findings are expected to inform policy formulation, guide the implementation of integrated community care strategies, and ultimately improve health outcomes and quality of life for older adults in urban China.

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