In Hospital Care and Welfare Standard

NCT ID: NCT01273116

Last Updated: 2013-01-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 404 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-01-31
• Study Completion Date: 2013-01-31

Brief Summary

The current organization of hospital care for older patients with complex healthcare needs is of insufficient quality, safety and efficiency. Frail older patients have a higher risk for development of complications and consequently a higher length of hospital stay, a higher risk of functional decline, and higher care needs after discharge. As nearly half of the patients admitted to Dutch hospitals is over 65 years, it is highly necessary to adapt the organization of hospital care to their needs. Besides having introduced the medical specialty geriatrics, hospital management has not started to provide hospital wide healthcare tailored to frail older patients. Therefore, the purpose of this study is to develop and examine the effectiveness of an intervention program for frail older patients admitted to hospital aimed at preventing functional decline and other hospital related negative outcomes.

Detailed Description

The long-term objective of this study is to examine the effectiveness and efficiency of an intervention program for frail older patients admitted to hospital. The specific aims are:

• To develop a model of integrated hospital care, according to the principle of the Chronic Care Model, focusing both on optimizing care and wellbeing. Feasibility of such a model of care was first evaluated in a pilot study.
• To conduct a before-after study to evaluate the outcomes associated with the proposed model of hospital care in frail older inpatients. Information on outcome indicators, including autonomy, quality of life, physical and cognitive functioning, and service utilization will be collected and compared before and after implementation of the proposed model of hospital care.

We expect that older patients who participate in the intervention program after one year of implementation, compared to patients who were admitted to hospital before implementation of the intervention program, will:

• have less functional decline during admission and after three months follow-up compared to two weeks before admission;
• have a lower incidence, severity and duration of delirium during admission;
• have less cognitive decline during admission;
• are more likely to be discharged directly to their own homes;
• have less weight loss between admission and discharge;
• experience less falls during admission;
• experience less readmissions within one month after discharge;
• have a shorter length of stay;
• have a significant different pattern of use of health care services after three months follow-up;
• experience more autonomy during hospital admission and better quality of life after three months follow-up.

Additionally, we expect that the knowledge and attitudes toward care for older patients among nurses and physicians will change positively during implementation of the intervention program.

Conditions

Functional Decline and Complications of Frail Older Patients Admitted to Hospital

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: NONE

Study Groups

CWS in Hospital

CWS in Hospital in addition to usual care

Group Type: EXPERIMENTAL

CWS in Hospital

Intervention Type: OTHER

Every patient aged ≥70 years will be screened for frailty. (For) every frail patient:

• will have a comprehensive (geriatric) assessment using an adapted version of the EasyCare instrument;
• a geriatric consultation team will propose/recommend a tailored care and welfare plan, which will be updated at the moment of discharge;
• will be discussed at least once in a multidisciplinary meeting;
• a structured medication review will be carried out by a geriatrician;
• is offered an activation programme by volunteers focusing on improvement of orientation, mobility, social activities or nutrition;
• may receive a consult of a geriatrician, if judged necessary;
• will receive extra attention on discharge arrangements.

Hospital staff will be educated, disease-specific guidelines will be adapted to frail older patients.

Interventions

CWS in Hospital

Every patient aged ≥70 years will be screened for frailty. (For) every frail patient:

• will have a comprehensive (geriatric) assessment using an adapted version of the EasyCare instrument;
• a geriatric consultation team will propose/recommend a tailored care and welfare plan, which will be updated at the moment of discharge;
• will be discussed at least once in a multidisciplinary meeting;
• a structured medication review will be carried out by a geriatrician;
• is offered an activation programme by volunteers focusing on improvement of orientation, mobility, social activities or nutrition;
• may receive a consult of a geriatrician, if judged necessary;
• will receive extra attention on discharge arrangements.

Hospital staff will be educated, disease-specific guidelines will be adapted to frail older patients.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Frail patients aged 70 years or older, admitted to one of the participating hospital wards
• Patients aged <70 years, but living in a nursing home or diagnosed with dementia (and therefore also judged as frail)

Exclusion Criteria

• Patients admitted <48 hours
• Palliative care is main goal of hospital admission
• Patients admitted and treated by physicians from non-participating wards and specialities
• Patients who do not speak or understand the Dutch language

• Minimum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

ZonMw: The Netherlands Organisation for Health Research and Development

OTHER

Sponsor Role: collaborator

Radboud University Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Marcel Olde Rikkert

prof dr

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Marcel GM Olde Rikkert, PhD

Role: PRINCIPAL_INVESTIGATOR

Radboud University Medical Center

Locations

Radboud University Nijmegen Medical Centre

Nijmegen, Gelderland, Netherlands

Countries

Netherlands

References

Bakker FC, Persoon A, Bredie SJH, van Haren-Willems J, Leferink VJ, Noyez L, Schoon Y, Olde Rikkert MGM. The CareWell in Hospital program to improve the quality of care for frail elderly inpatients: results of a before-after study with focus on surgical patients. Am J Surg. 2014 Nov;208(5):735-746. doi: 10.1016/j.amjsurg.2014.04.009. Epub 2014 Jun 27.

Reference Type: DERIVED

PMID: 25085385 (View on PubMed)

Other Identifiers

Nr. 60-61900-98-272, NPO

Identifier Type: -

Identifier Source: org_study_id