Optimized Acute Care for Geriatric Patients Using an Intersectoral Telemedical Cooperation Network - Around the Clock
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Emergencies
- Sponsor
- RWTH Aachen University
- Enrollment
- 1600
- Locations
- 1
- Primary Endpoint
- Number of Intervention-related adverse events
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
Due to "demographic change", the composition of the population in Germany is changing. The consequence of this change is a population that is getting older on average. A key challenge is the appropriate nursing and medical care of older people in senior residences and care facilities. The increasing workload for nursing staff and doctors in the outpatient sector means that timely care for patients, e.g. in the form of GP visits, cannot always be guaranteed in a timely manner. The results are unnecessary or premature hospital admissions as well as ambulance and emergency care interventions, even though in many cases it is not an acute or even life-threatening event. Furthermore, it has been scientifically proven that hospital admissions can increase the risk of patients becoming confused. The aim of this project is to avoid unnecessary hospital admissions and to enable patients to remain in their familiar surroundings as far as this appears medically justifiable. At the same time, the study aims to improve the medical care of nursing home residents through better networking of medical areas, the use of tele-consultations and an early warning system.
Detailed Description
The Optimal@NRW project represents a new cross-sectoral approach to the acute care and support of geriatric people in need of care through the implementation of an early warning system and the integration of a telemedical consultation system in 25 nursing homes in the region of Aachen in Germany. The project focuses on restructuring emergency care in nursing homes and improving cooperation between the actors involved (emergency service, emergency department, general practitioners, nursing staff, etc.). Accordingly, a central emergency number of the statutory health insurance funds is to act as a virtual hub for the care of geriatric patients. The concrete approach of the project is that the participating nursing homes first contact the medical call centre (116 117) in case of a medical problem. The call centre is then responsible for an initial medical assessment and decides whether the respective GP can be called in or whether a teleconsultation with the "virtual digital desk" (i.e. the medical experts from the emergency department of the University Hospital RWTH Aachen) should be carried out. In addition, mobile nursing assistants (NÄPÄ (Z)) will be introduced as part of the project, who can also support the nursing staff and provide services that can be delegated by doctors - especially if the general practitioner is not available at the time. In addition, a standardised early warning system is to be established in the nursing homes and its benefits evaluated. This will enable potentially dangerous changes in the state of health of nursing home residents to be detected earlier.
Investigators
Jörg Christian Brokmann
PD Dr. med.
RWTH Aachen University
Eligibility Criteria
Inclusion Criteria
- •Resident of one of the participating nursing homes
- •At least 18 years old
- •Written informed consent
- •Consent of the guardian for residents who are not legally able to give consent
Exclusion Criteria
- •Persons placed in an institution by order of an authority or court
- •Persons who are in a dependent or employment relationship with the investigator
Outcomes
Primary Outcomes
Number of Intervention-related adverse events
Time Frame: 6 to 15 months depending on the cluster affiliation
* Resuscitation during teleconsultation * Unexpected death during teleconsultation * Unexpected death within 24 hours after teleconsultation * Unexpected hospitalisation within 24 hours of teleconsultation * Unexpected death while wearing a biosensor (if available)
Days spent at hospital
Time Frame: 24 months
Days spent at hospital
Secondary Outcomes
- Applicability of an early warning score in nursing homes(6 to 15 months depending on the cluster affiliation)
- Number of ambulatory sensitive hospital cases(24 months)
- hospital referrals and use of primary care physicians and physicians of the GP emergency service before and after the implementation of telemedicine in nursing homes(9 to 18 months depending on the cluster affiliation)
- Rate of guideline deviations in diagnostics and therapy for specific tracer diagnoses (e.g. hypertension/blood pressure derailment, blood sugar derailment, infections - community-acquired (urinary tract infection, bronchitis, pneumonia))(24 months)
- Days spent at nursing home(24 months)
- Number of double prescriptions(24 months)
- Cost effects via HCRU(24 months)
- Quality of Life - VR-12(24 months)
- Number of adverse events due to medication(24 months)
- Number of admissions to hospital(24 months)
- Dementia Screening Scale (DSS)(24 months)
- Number of hospitalizations due to medication(24 months)
- Need for additional staff in case of telemedical call(24 months)
- Amount of ambulance service calls(24 months)
- Number of medical contacts(24 months)
- Time to doctor contact(24 months)
- Barthel Index(24 months)
- Time-to-event concerning medication and hospitalization(24 months)
- Response times in doctor-patient contact(24 months)
- Number of incorrect suspected diagnoses compared to diagnoses after teleconsultation or admission to hospital(24 months)
- Rate of applicability of an early warning score in nursing homes(6 to 15 months depending on the cluster affiliation)
- Amount of use of medical services(24 months)
- Transport units used(24 months)
- Quality of Life - QOL-AD(24 months)
- Evaluation of the processes, NÄPA (Z) operations and tele consultations(6 to 15 months depending on the cluster affiliation)
- Gender differences(24 months)