Improving and Evaluation of a New Cross-sectoral Hospital at Home Model for Elderly Acute Ill Patients
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 849
- 试验地点
- 4
- 主要终点
- Rate of 30-days re-admission
研究概览
简要总结
Many elderly patients with uncomplicated treatment courses are admitted unnecessarily, which is a burden for the patient and society. Studies show that Hospital at Home (HaH) treatment is an alternative to hospitalization. The patient's risk of delirium, infection and loss of function is reduced when the patient avoids the hospital stay. HaH treatment is expected to be more cost-effective, improve patients' functional abilities and patients' satisfaction.
Three municipalities, general practitioners, pre-hospital service and an emergency department (ED) in Central Denmark Region have organized the first HaH treatment model across disciplines and sectors. Specialists in the ED and the municipal acute teams provide HaH treatment for elderly acute ill patients. However, the model has not yet been evaluated.
The aim of this study is to optimize the HaH treatment model for elderly acute ill patients. The objective is to increase patient satisfaction and optimize the use of resources in healthcare by avoiding unnecessary hospitalizations that impair and prolong treatment.
This study is an open label randomized controlled trial (RCT) with a 1:2 allocation ratio of acute hospital admission versus HaH. During a pilot period, we tested and adapted the patient pathway of HaH to the practical reality, before we start the randomization for the RCT study. We will investigate the clinical effects and health economic consequences of HaH treatment compared with standard hospital treatment.
详细描述
Background
The Danish population that is above 65 years of age is expected to increase from 16% today to 25% in 2042. This will result in a larger demand for health care services, which is a task that the Danish hospital sector cannot perform alone. Emergency hospital admissions are not the best solution for treatment of all patients. For elderly, frail citizens an emergency admission is a big change in the daily life and often means a great risk of infection and delirium and loss of functional ability which takes a long time to regain.
The group of elderly medical patients is a broad group that demand a coherent and cross-sectoral treatment. This patient group is often only hospitalized for a short period. The hospitalization of these patients with rather uncomplicated treatment could possibly have been prevented if the collaboration between hospital, general practitioners (GPs), pre-hospital service and municipalities had been improved further.
These complex challenges underscore the need to explore innovative solutions. An alternative model of care that internationally has been identified as a possible solution is the Hospital at Home (HaH) treatment model. This model offers active treatment of a condition that otherwise would have demanded emergency admission and can be performed over a shorter period of time in patients' own home. Studies have shown that it is better for elderly patients to be treated in-home, and that patients that are treated in own home are more satisfied with their continuity of care. Many of these services are adjusted for elderly patients, but the services can be organized in different ways, focusing on different categories of patients.
During the last four years, GPs, an emergency department (ED), pre-hospital service, three municipalities, as well as researchers have organized the first HaH treatment model for elderly acute ill patients in a Danish context, but it has not yet been implemented or evaluated. The aim of this study is to optimize the HaH treatment model for elderly acute ill patients. The objective is to increase patient satisfaction and optimize the use of resources in healthcare by avoiding unnecessary hospitalizations that impair and prolong treatment. We will investigate the clinical effects and health economic consequences of HaH treatment compared with standard hospital treatment using an open labelled RCT design.
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
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •The patient should be aged 65 and over
- •Diagnosed with a stable acute medical conditions e.g. cystitis, erysipelas, pneumonia
- •The patient should be living in their own home or a nursing home before entering the study
- •The patient should be residing in one of the three municipalities (Viborg, Skive and Silkeborg)
- •The patient must have been seen by the GP or the pre-hospital service in the case of disease in question
- •The patient should speak and understand Danish.
- •The patient should give informed consent to participate in the study.
排除标准
- •The patient is unable to give written consent
- •The capacity of the municipal acut team care was fully utilised.
结局指标
主要结局
Rate of 30-days re-admission
时间窗: 30 days period after discharge
Rate of 30-days re-admission after discharge
Health Related Quality of Life
时间窗: From inclusion to 3 months follow-up
Estimating quality of life by using EuroQoL-5 Dimensions. We will use EuroQoL-5 Dimensions to measure Health Related Quality of Life. The five dimensions include mobility, self-care, usual activity, pain/discomfort and anexiety/depression.This tool will provide us with health states (11111 being the best health state and 55555 the worse health state). We will use the Danish weight to give weights to different health states obtained from EuroQoL-5 Dimensions.
次要结局
- Mortality rate(From inclusion to 3 months follow-up)
- Number of contacts to primary and secondary health care system(From inclusion to 3 months follow-up)
- Functional mobility test(From inclusion to 3 months follow-up)
研究者
Camilla Palmhøj Nielsen
Research director
Defactum, Central Denmark Region