Quantitative evaluation of an outreach case management model of care for urban Aboriginal and Torres Strait Islander adults living with complex chronic disease: a longitudinal study

Table 1 Schedule and content of assessments for HOME Study participants

	Baseline	3-months	6-months	12-months
Variables assessed from medical chart audit
Chronic disease diagnoses*	✓	✓	✓	✓
HbA1c (%)	✓	✓	✓	✓
Body Mass Index (kg/m²)	✓	✓	✓	✓
Blood pressure (mmHg)	✓	✓	✓	✓
Health services utilisation	✓	✓	✓	✓
Medications	✓	✓	✓	✓
Variables assessed during home assessments
Socio-demographics	✓
Depression^a	✓		✓	✓
Social and emotional wellbeing	✓		✓	✓
Self-rated health status^b	✓		✓	✓
Lifestyle factors	✓	✓	✓	✓
Medication use and medication literacy	✓	✓	✓	✓

* At baseline, current diagnoses of chronic diseases were recorded. New diagnoses were recorded at subsequent assessments;^aDepression assessed using adapted PHQ-9 – dichotomised as moderate to severe depression vs. otherwise; ^bSelf-rated health status dichotomised as good, very good or excellent vs. poor or fair;

ISSN: 1472-6963