Discussion
We evaluated the effectiveness of a new, anticipatory, multidisciplinary care service in improving the wellbeing and quality of life for older people living with severe frailty. This study showed that the new service improved wellbeing and quality of life for this study population at 2-4 weeks; the improvement in wellbeing was sustained at 3 months. We chose a short observation time because we expect the benefit from improved symptom control and additional support will have maximal effect at 2-4 weeks. The improvement in wellbeing and quality of life associated with the new integrated care service is greater than that previously reported as clinically meaningful by patients with advanced illness [Choosing the right primary outcome measure is important; we found greater change in wellbeing (measured with IPOS) than in quality of life (measured with EQ-5D-5L). IPOS can detect clinically meaningful changes in symptoms and other concerns over time, and is more specific to the concerns of those with advanced illness. Quality of life, in contrast, is subject to a much wider range of influences. The domains included in IPOS are those prioritised as most important by patients with advanced illness themselves [We used a Comprehensive Geriatric Assessment (CGA)-based intervention – a multi-modal screening and treatment approach that identifies the medical, psychological and functional needs of older adults [