To break through the current bottleneck in home-based older care globally, we developed an intelligent and integrated older care model (SMART model) to facilitate integrated care for home-dwelling older people. As a knowledge-based clinical decision support system, the SMART model relies on rules and algorithms to ensure its transparent and well-supported decision-making process with clear rationales. Therefore, we conducted a mixed study combining qualitative research, literature review of the latest literature and guidelines, and expert consultation. Following the intervention mapping framework and nursing process, we determined 138 care problems along with their diagnostic criteria and care goals. Building upon this, we curated 450 evidence-informed methods, each accompanied by at least one implementation approach. Two sets of IF-THEN rules and algorithms including diagnostic rules and method trigger rules were employed to trigger appropriate care problems and customized methods and implementation approaches.