Optimized Acute Care for Geriatric Patients Using an Intersectoral Telemedical Cooperation Network - Around the Clock
- Conditions
- Emergencies
- Interventions
- Other: Telemedical support
- Registration Number
- NCT04879537
- Lead Sponsor
- RWTH Aachen University
- 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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1600
- 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
- Persons placed in an institution by order of an authority or court
- Persons who are in a dependent or employment relationship with the investigator
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Telemedical support Telemedical support Participants in this group are routinely treated with additional telemedical support and the use of the early warning system.
- Primary Outcome Measures
Name Time Method Number of Intervention-related adverse events 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 24 months Days spent at hospital
- Secondary Outcome Measures
Name Time Method Need for additional staff in case of telemedical call 24 months Need for additional staff in case of telemedical call
Number of ambulatory sensitive hospital cases 24 months Number of ambulatory sensitive hospital cases
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 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
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 Reasons for deviations (lack of knowledge, individual knowledge about patient, allergies, living will, local conditions/treatment resources, patient wishes)
Applicability of an early warning score in nursing homes 6 to 15 months depending on the cluster affiliation Incidence of correct recognition of deteriorating medical conditions
Days spent at nursing home 24 months Days spent at nursing home
Cost effects via HCRU 24 months Cost effects via HCRU
Quality of Life - VR-12 24 months Quality of life assessed using Veterans Rand 12 Item Health Survey (VR-12). The outcome includes a physical and mental health component score (PCS and MCS, respectively). Each component score (PCS and MCS) has a range of 0-100, with a higher score on the PCS and MCS indicating better outcome, or better physical or mental health-related quality of life, respectively.
Number of adverse events due to medication 24 months Number of adverse events due to medication (drug therapy safety)
Number of admissions to hospital 24 months Admission to hospital in general and to specific diagnosis
Dementia Screening Scale (DSS) 24 months Identification of people with dementia syndromes in inpatient care for the elderly using Dementia Screening Scale (DSS). Score of the DSS ranging from 0 to 14. When 0 is the minimum (no impairment) and 14 is the maximum (maximum impairment).
Number of hospitalizations due to medication 24 months Number of hospitalizations due to medication (drug therapy safety)
Amount of ambulance service calls 24 months Amount of ambulance service calls
Number of medical contacts 24 months Number of medical contacts
Time to doctor contact 24 months Time to doctor contact
Barthel Index 24 months Assessment procedures of daily living skills assessed via Barthel Index. Score of the Barthel Index ranging from 0 to 100 were collected when 0 is the minimum (worst outcome) and 100 is the maximum (best outcome).
Number of double prescriptions 24 months Number of double prescriptions (drug therapy safety)
Time-to-event concerning medication and hospitalization 24 months Time-to-event concerning medication and hospitalization (drug therapy safety)
Response times in doctor-patient contact 24 months Response times in doctor-patient contact before and after the implementation of telemedicine in nursing homes
Number of incorrect suspected diagnoses compared to diagnoses after teleconsultation or admission to hospital 24 months - Causes of inaccurate suspected diagnoses
Rate of applicability of an early warning score in nursing homes 6 to 15 months depending on the cluster affiliation - tracer-diagnoses: fever, urinary-tract infection, pneumonia, cardiac decompensation, cardiac arrhythmia, reduced vigilance, hypertension, hypo-/hyperglycaemia, pain
Amount of use of medical services 24 months Use of medical services
Transport units used 24 months Transport units used
Quality of Life - QOL-AD 24 months Quality of life assessed using Quality of Life-Alzheimer's Disease (QoL-AD). The total score ranges from 13 to 52, with a higher number indicating better quality of life
Evaluation of the processes, NÄPA (Z) operations and tele consultations 6 to 15 months depending on the cluster affiliation Questionnaire about the acceptance of nursing home staff
Gender differences 24 months Gender differences
Trial Locations
- Locations (1)
University Hospital RWTH Aachen
🇩🇪Aachen, Germany