Development and Validation of a Comprehensive Management Service Package for Older Adults With Multimorbidity

ConditionsMultimorbidity Hypertension Diabetes Mellitus Coronary Artery Disease Dyslipidemia Stroke Arthritis Cognitive Impairment Depression - Major Depressive Disorder Chronic Kidney Disease Chronic Liver Diseases

Trial statusNot yet recruiting

Trial phaseNot applicable

Trial typeInterventional

Biological sexAll

Age65+

SponsorXuanwu Hospital, Beijing

About this trial

This study aims to test a new comprehensive management service package for older adults with two or more chronic conditions (multimorbidity). The package includes digital health tools, personalized guidance, and long-term management support. Researchers will compare the service package with usual care to see whether it reduces hospital readmissions, improves quality of life, and supports daily functioning. About 394 participants will be randomly assigned to either the service package group or the usual care group. Participants will be followed for 6 months to measure health outcomes, treatment adherence, and safety.

Eligibility criteria

Qualifiers

Age ≥65 years

Diagnosed with ≥2 chronic diseases or geriatric syndromes (e.g., hypertension, diabetes, frailty, depression)

Willing to provide informed consent

Disqualifiers

Life expectancy <1 year due to severe illness (e.g., cardiogenic shock)

Currently participating in other clinical trials

Trial design

Treatments tested in this trial

Service Package Group

Treatment groups

358 Participants

are divided into 2 treatment groups

Locations

This trial has no locations

Sponsors and collaborators

Xuanwu Hospital, Beijing

Lead sponsor

Source ClinicalTrials.gov