Factors Predisposing to Inappropriate Transfers of Nursing Home Residents to Emergency Departments
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,040
- 试验地点
- 16
- 主要终点
- Inappropriate transfer to ED of NH residents
研究概览
简要总结
According to the data of our nursing homes (NH) research network (REHPA - Gérontopôle Toulouse, 345 nursing home in France), 13.5% of NH residents are hospitalized every 3 months or about 50% per year. These hospitalizations concern for half, transfers to emergency department (ED). Data from the literature and the PLEIAD study, conducted with 300 NH in France, confirm that intense flows between NH and ED. These studies also support the idea that these transfers to ED potentially expose some NH residents to iatrogenic complications, a risk of functional decline, an increased risk of mortality, and generate additional health costs. To transfer to ED residents who will benefit from emergency care and not to transfer to ED residents for whom this transfer generates a higher risk than the expected benefit is the goal to reach to guarantee the better quality of care for NH residents.
Inappropriate transfer to ED may be defined by the absence of somatic emergency and / or palliative care known before transferring to ED and / or the presence of advance directives of non-hospitalization in the resident's file. This is a clinical situation that could be managed by other means that the transfer to ED without loss of opportunity for the patient.
The primary objective of our study is to determine the factors predisposing NH residents to inappropriate transfer to ED.
Our hypothesis is that inappropriate transfers to the ED of NH residents are conditioned by factors accessible to interventions such as the organization of the NH care system or by improving the management of some diseases in NH. Investigators also hypothesize that the cost of inappropriate transfers to the ED is considerable. Acknowledgement of costs generated by inappropriate transfers to ED would allow policy makers to make strategic decisions to improve care system.
详细描述
This is a retroprospective study conducted in sixteen hospitals in south-west of France. Inclusion will last one year, including 4 periods (one per season) of 7 days (24h / 24, including necessarily each day of the week). All the NH residents admitted in ED will be included. For each resident included, medical and non-medical data will be collected in 4 times: retrospectively before transfer to ED (=T0); and prospectively : at ED (= T1), in hospital services in case the patient is hospitalized (=T2) and at the patient's return to NH (=T3).
At T0 data collected will concern the NH and resident basis medical state, resident's medical state the week before transfer and resident medical state before transfer to ED.
At T3 data collected will concern the resident's return modality and his/her autonomy 7 days after his/her return
Time frame:
between T1 and T3 : mean expected duration will variate from few hours if the resident isn't hospitalized (ED visit) to an average 12.4 days, which is the average length of hospital stay of NH resident hospitalized after a transfer to ED (cf Pleiad study, Rolland 2012) plus 7 days as Investigators will collect T3's data 7 days after the NH resident's return to NH
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Retrospective
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •to live in a Nursing Home
- •to be directly transferred from the NH to ED
- •to have not previously been included in FINE study
排除标准
- •to live in structures other than Nursing Home (i.e. sheltered housing, seniors' residences, housing homes, retirement homes, long-term care units)
- •to live in the community
- •to be transferred to ED from elsewhere than the NH
- •to have previously been included in FINE study
结局指标
主要结局
Inappropriate transfer to ED of NH residents
时间窗: Baseline (T1 = inclusion at ED): retro-prospectively by the group of experts
Inappropriateness of the NH residents' transfers to ED : the inappropriateness of ED transfers will be determined by the opinion of a group of experts composed of geriatricians, emergency physicians, general practitioners and pharmacists. Inappropriate transfer to ED is defined by the absence of somatic emergency and / or palliative care known before decision to transfer and / or the presence of advance directives of non-hospitalization in the resident's file. This is a clinical situation that could be managed by other means that the transition to ED without loss of opportunity for the resident. To judge the inappropriateness of the transfer to ED, the group of experts will use a rating scale of usual emergencies. Individual and independent rating divergences will lead to a concerted evaluation of the clinical situation by the group. Analyse retro-prospectively by the group of experts.
次要结局
- Avoidability of the NH resident transfer to ED(Baseline (T1 = inclusion at ED))
- Cost of the NH resident transfer to ED(6 months before to 6 months after the transfer)
- Analysis of Medical prescription, with a focus on psychotropic drug(Change at different time points: T1 (baseline), T2 (up to 12 days,if concerned) and T3 (7 days after return to NH))
- NH resident's autonomy using Katz'ADL(Change at different time points: T0, T2 (up to 12 days,if concerned) and T3 (7 days after return to NH))