Efficacy of Integrated Care to Decrease Hospitalization and Institutionalization in Community Dwelling Frail Elderly, With Care Coordination Between Physicians, Home Nursing Services and a Community Geriatrics Unit.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 301
- 试验地点
- 2
- 主要终点
- Hospitalizations: rates of first hospitalization, number and reason
研究概览
简要总结
Introduction: Care of frail and dependent elders with multiple chronic conditions is a major challenge for health care systems. The objective of this study is to evaluate the effect of coordinating the existing structures in the private and public sector for the care of frail and dependent persons over age 60, and susceptible of presenting complex bio-psycho-social issues. This approach is aimed at improving the coordination, continuity, quality and efficacy of care in this population, which presents a high risk of hospitalization, emergency room visits, institutionalization and mortality.
Methods: Three-year cluster randomised controlled trial. A control group receiving usual care (follow up by primary care physician and home nursing service) will be compared to an intervention group that will be provided, in addition, in-home multidimensional geriatric assessment with access to a 24h/7 day a week call service, and coordinated long-term follow-up. Survival analyses will be conducted to compare the outcomes between groups.
Primary outcome:
- Hospitalizations: rates of first hospitalization, number, cause and length of stay.
Secondary outcomes:
- Emergency room visits: rates of first visit, number and cause
- Institutionalization: number of patients
- Mortality: rate and number of deaths and place of death (home versus hospital)
详细描述
Background Since the second half of the twentieth century, a major prolongation in life expectancy has led to a rapid increase in the number of older adults in Switzerland, with a high prevalence of multiple chronic diseases, functional incapacities and cognitive deficits.
In general, care of the frail elderly is characterized by fragmentation and discontinuity within and between sectors, resulting in frequent and inappropriate hospitalizations and premature nursing home placement with an increase in health care costs. Furthermore, many older patients with progressive chronic diseases prefer to die at home, but more than 50 percent will do so in hospital, with multiple hospitalizations in their final year. This is mostly related to the availability of health resources in the community.
Care-giver burden with increased morbidity in this population is an often hidden consequence of caring for dependent older adults.
A study performed in 2003 at the University Hospital of Geneva emergency room5 showed that among 255 patients (mean age 79 years) evaluated during a three-month period for inability to stay at home, 59 percent had no acute medical problem but rather a breakdown of their informal support system. Ninety per cent were frail and dependent, and 85 percent had not been evaluated by their primary care physician previous to their arrival to the emergency room. This study suggests that many needs and disabilities of the frail elderly are not identified and that the lack of coordination between the different actors of the community primary health care system does not enable these patients to stay at home.
Consequently, there has been an increasing interest in the ability of integrated models of care to improve health outcomes and shift service utilization from the institutional setting into the community.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 60 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients followed by the home nursing service and primary care physician
- •Over 60 years of age
- •Able to give consent (patient or caregiver)
- •Able to speak French
- •Meeting frailty criteria as determined by one of the following alarms detected by the RAI-HC:
- •Alarm 8: cognition
- •Alarm 12: social role and function
- •Alarm 15: falls
- •Alarm 22: frailty of the informal care giver system.
排除标准
- •Age under 60 years
- •Unable (patient or caregiver) to give informed consent
- •Unable to communicate adequately in French
- •Patients' not receiving nursing visits (only receiving practical aid or services from occupational therapists).
结局指标
主要结局
Hospitalizations: rates of first hospitalization, number and reason
时间窗: Three years
次要结局
- Emergency room visits: rates of first visit, number and cause.(Three years)
- Institutionalization: number of patients(Three years)
- Mortality: rate and number of deaths and place of death (home versus hospital)(Three years)
研究者
Laura Di Pollina
Doctor in medecin
University Hospital, Geneva