Impact of a Transitional Care Program Involving an Advanced Practice Nurse on 30-Day Hospital Readmissions for Elderly Patients Discharged From a Short Stay Geriatric Ward (PROUST Study)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 630
- 试验地点
- 12
- 主要终点
- 30-Day unscheduled hospital readmission or emergency visit rate after the index hospital discharge.
研究概览
简要总结
In France, it has be estimated that the hospital readmission rate within 30 days of patients aged 75 or older is 14% (IC95% [12.0-16.7]), nearly a quarter being avoidable. There is evidence that interventions "bridging" the transition from hospital to home involving a dedicated professional (usually nurses) would be most effective in reducing the risk of readmission, but the level of evidence of current studies is low. Our study aims to assess the impact of a program of transitional care from hospital to home for people of 75 years old or more admitted to acute care.
详细描述
The study is a stepped wedge randomized cluster study. Intervention: The transition care program, involving a dedicated advanced practice nurse, will include: 1) during the patient's stay in hospital: an individualized needs-based comprehensive discharge plan and a transitional care record ; the notification of the primary care physician about inpatient care and hospital discharge; 2) the day of the discharge: specific explanations about the organization of home care provided by the transition care nurse to the patient; 3) during 4 weeks after discharge: monitoring patients and caregivers regularly through home visits and/or telephone contact,
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 75 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient hospitalized for 48 hours or more in one of the acute geriatric service participating to the study.
- •Aged 75 or older.
- •Leaving at home and with home as the planned discharge after the admission.
- •At risk of hospital readmission emergency visit rates after discharge (if he has two or more of the following criteria (taken from the Triage Risk Screening Tool and from the 2013 French recommendation)).
排除标准
- •Patient leaving in a retirement home.
- •Patient hospitalized at home.
- •Patient leaving at home but at 30 km (18 miles) or more from the service of his index admission
研究组 & 干预措施
Transitional care program.
The transitional care program from hospital to home will be implemented at three steps: during the patient's stay in hospital, the day of the discharge and during 4 weeks after discharge.
干预措施: Transitional care program. (Other)
standard care program
No intervention liable to affect the care provided to the patients, the organization of care or the practices of health care professionals will be implemented during the control period (time steps without intervention).
干预措施: standard care program (Other)
结局指标
主要结局
30-Day unscheduled hospital readmission or emergency visit rate after the index hospital discharge.
时间窗: Within 30 days after hospital discharge.
Unscheduled hospital readmissions are hospitalizations that are not planned at the moment of the discharge (for example: hospitalization after an emergency visit or upon request of the primary care physician).
次要结局
- Adverse events (i.e. falls)(Within 30 days after the index hospital discharge.)
- Length of stay in the short stay geriatric ward (index hospitalization)(Patients will be followed for the duration of hospital stay, an expected average between 2 days and 30 days)
- Free-hospitalization survival(Within 30 and 90 days after the index hospital discharge.)
- Mortality rate(Within 30 and 90 days after the index hospital discharge.)
- Unscheduled hospital readmissions or emergency room visits(Within 30 and 90 days after the index hospital discharge.)
- Patients' satisfaction care transition programme(Within 30 days after the index hospital discharge.)
- Number of contacts between the transition nurse and the primary care providers or the hospital providers after discharge(Within 30 days after the index hospital discharge.)
- Costs of unscheduled hospital readmission or emergency visit(30 days after discharge)
- Quality of life.(Within 30 days after the index hospital discharge.)
- Delay between the index hospital discharge and the implementation of home care.(Within 30 days after the index hospital discharge.)