Evaluation of Community-based Care for the Frail Elderly

Not Applicable

• Conditions: Frail Elderly Syndrome; Chronic Disease
• Interventions: Other: Advanced care for frail elderly

• Registration Number: NCT03768050
• Lead Sponsor: Hospital Clinic of Barcelona

Brief Summary

The term frail chronic complex patient (CCP) is generally applied to subjects with heterogeneous conditions that may represent at least one of the following three traits: (i) the need for management by a number of specialists from different disciplines that often leads to high use of healthcare resources; (ii) fragility, which requires additional support either due to functional decline, social deficits and/or transient situations such as hospital discharge or, (iii) the need for highly specialised care with home technological support.

The current protocol deals with the second category of patients, frail CCP, and addresses horizontal integration of community-based services. It is based in the city of Badalona (216K inhabitants), within the metropolitan area of Barcelona. Badalona Serveis Assistencials (BSA) is the service provider of integrated care services for this population.

Detailed Description

The study will assess three types of specific groups of patients: (i) Early discharge group includes patients acutely admitted to the medical and/or surgical hospital wards and promptly discharged to receive home-based post-acute care and/or rehabilitation; (ii) Home-based Case Management group includes complex chronic patients or patients receiving long-term care by a case management nurse; and (iii) Geriatric residences group will include patients receiving acute support, post-acute or continued care for elderly people living in geriatric residences.

It will be conducted by Badalona Serveis Assistencials (BSA), an integrated care service provider located in the city of Badalona (420K inhabitants) in the North-Eastern part of the Barcelona Metropolitan Area.

The current study protocol aims to assess cost-effectiveness of the three types of interventions for frail patients, as well as to generate a roadmap for regional scalability of the service. The study design will consist of a prospective quasi-experimental case-control design wherein each intervention group will be compared with the corresponding usual care group (controls, 1:1 ratio), using propensity score matching. Age, sex, GMA (adjusted morbidity groups), socioeconomic status, number of hospitalisations during the previous year and polypharmacy will be used as matching variables.

Study Timeline

• Study Start: 2018-04-01
• Study First Submitted: 2018-11-28
• Status Verified: 2018-12
• Study First Submitted QC: 2018-12-05
• Last Update Submitted: 2018-12-05
• Study First Posted: 2018-12-07
• Last Update Posted: 2018-12-07
• Primary Completion: 2019-03-01
• Study Completion: 2019-04-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 500

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Advanced care for frail elderly	Advanced care for frail elderly	Integrated care program for frail elderly covering Home Hospitalization/Early Discharge; geriatric residences and; home-based case management done by dedicated teams specialised in geriatric medicine

Primary Outcome Measures

Name	Time	Method
Costs	30 days	Health Care Costs

Secondary Outcome Measures

Name	Time	Method
Number of hospital admissions	30 days	Number of hospital admissions during the study period
Continuity of care within the healthcare system	30 days	Continuity of care within the healthcare system as measured by the Nijmegen Continuity of Care Questionnaire
Patient centred healthcare provision	30 days	Patient centred healthcare provision as measured by the Person Centred Coordinated Experience Questionnaire

Trial Locations

Locations (1)

Hospital Clinic; 🇪🇸 Barcelona, Catalonia, Spain