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Clinical Trials/DRKS00031500
DRKS00031500
Recruiting
Not Applicable

Personalized, interdisziplinary patient pathway to cross-sector care of multimorbid patients - eliPfad

niversität zu Köln0 sites946 target enrollmentAugust 14, 2023

Overview

Phase
Not Applicable
Intervention
Not specified
Conditions
I50
Sponsor
niversität zu Köln
Enrollment
946
Status
Recruiting
Last Updated
last year

Overview

Brief Summary

No summary available.

Registry
who.int
Start Date
August 14, 2023
End Date
TBD
Last Updated
last year
Study Type
Observational
Sex
All

Investigators

Sponsor
niversität zu Köln

Eligibility Criteria

Inclusion Criteria

  • Acute inpatient admission or transfer to a normal ward of a participating center due to an internal disease (initial admission diagnosis) in the form of:
  • o direct admission from home / from the referring resident HA / FA
  • o Transfer from the in\-house emergency room
  • o Admission from an external hospital (reason for admission: internal medicine)
  • o Admission from another care unit within the hospital .
  • \- Age \= 55 years
  • \- multimorbid patients (at least 3 diseases)
  • \- At least one of the following index diagnoses:
  • o heart failure (HI) (NYHA I\-IV)
  • o Renal insufficiency (NI)

Exclusion Criteria

  • \- Patients with a non\-internal medicine initial reason for admission (this includes the reason for admission for initial admission to an external hospital).
  • \- Patients who can be discharged within a maximum of 2 working days
  • \- Residents of nursing facilities, 24\-hour home care, predominant bedriddenness
  • \- lack of rehabilitation potential according to the assessment of the attending physician
  • \- insufficient German language skills among patients and relatives / acquaintances
  • \- higher degree of visual and/or hearing impairment
  • \- illnesses with a life expectancy of less than 6 months
  • \- desired rehabilitation on day 1 to 42 after discharge from index hospitalization
  • \- distance to the patient's home of significant more than 50 km (individual decision)
  • \- Persons who have private health insurance

Outcomes

Primary Outcomes

Not specified

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