Factors Predisposing to Inappropriate Transfers of Nursing Home Residents to Emergency Departments

NCT ID: NCT02677272

Last Updated: 2024-02-23

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 1040 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2016-01-01
• Study Completion Date: 2018-07-31

Brief Summary

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.

Detailed Description

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

Conditions

Frail Elderly

Study Design

• Observational Model Type: CASE_ONLY
• Study Time Perspective: RETROSPECTIVE

Interventions

Appropriateness of NH resident's transfer to ED

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• to live in a Nursing Home
• to be directly transferred from the NH to ED
• to have not previously been included in FINE study

Exclusion Criteria

• 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

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Agence Régionale de la Santé - Midi Pyrénées

OTHER_GOV

Sponsor Role: collaborator

Ministry of Health, France

OTHER_GOV

Sponsor Role: collaborator

University Hospital, Toulouse

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Yves ROLLAND, MD PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Toulouse

Locations

CH d'Albi

Albi, , France

CH d'Auch

Auch, , France

CH de Cahors

Cahors, , France

CHI Castres Mazamet

Castres, , France

CH Ariège Couserans

Foix, , France

CH de Gourdon

Gourdon, , France

CH Lannemezan

Lannemezan, , France

CH Lavaur

Lavaur, , France

CH de Lourdes

Lourdes, , France

CH Castelsarrasin Moissac

Moissac, , France

CH Montauban

Montauban, , France

CH Rodez

Rodez, , France

CH Saint Gaudens

Saint-Gaudens, , France

CHI Val d'Ariège

Saint-Girons, , France

Toulouse University Hospital (CHU de Toulouse)

Toulouse, , France

CH de Bigorre

Vic-en-Bigorre, , France

Countries

France

References

Perrin A, Tavassoli N, Mathieu C, Hermabessiere S, Houles M, McCambridge C, Magre E, Fernandez S, Caquelard A, Charpentier S, Lauque D, Azema O, Bismuth S, Chicoulaa B, Oustric S, Costa N, Molinier L, Vellas B, Berard E, Rolland Y. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol. Contemp Clin Trials Commun. 2017 Jul 21;7:217-223. doi: 10.1016/j.conctc.2017.07.005. eCollection 2017 Sep.

Reference Type: BACKGROUND

PMID: 29696189 (View on PubMed)

Rolland Y, Mathieu C, Tavassoli N, Berard E, Laffon de Mazieres C, Hermabessiere S, Houles M, Perrin A, Krams T, Qassemi S, Cambon A, Magre E, Cantet C, Charpentier S, Lauque D, Azema O, Chicoulaa B, Oustric S, McCambridge C, Gombault-Datzenko E, Molinier L, Costa N, De Souto Barreto P. Factors Associated with Potentially Inappropriate Transfer to the Emergency Department among Nursing Home Residents. J Am Med Dir Assoc. 2021 Dec;22(12):2579-2586.e7. doi: 10.1016/j.jamda.2021.04.002. Epub 2021 May 5.

Reference Type: RESULT

PMID: 33964225 (View on PubMed)

Bouzid W, Cantet C, Berard E, Mathieu C, Hermabessiere S, Houles M, Krams T, Qassemi S, Cambon A, McCambridge C, Tavassoli N, Rolland Y. Exploring Predictive Factors for Potentially Avoidable Emergency Department Transfers: Findings From the FINE Study. J Am Med Dir Assoc. 2024 Apr;25(4):572-579.e1. doi: 10.1016/j.jamda.2023.11.017. Epub 2023 Dec 27.

Reference Type: RESULT

PMID: 38159914 (View on PubMed)

Dubucs X, Balen F, Charpentier S, Lauque D, De Souto Barreto P, Tavassoli N, Houze-Cerfon CH, Rolland Y. Factors associated with Emergency Medical Dispatcher request and residents' inappropriate transfers from Nursing Homes to Emergency Department. Eur Geriatr Med. 2022 Apr;13(2):351-357. doi: 10.1007/s41999-021-00574-5. Epub 2021 Oct 15.

Reference Type: RESULT

PMID: 34652784 (View on PubMed)

Gombault-Datzenko E, Costa N, Mounie M, Tavassoli N, Mathieu C, Roussel H, Lagarrigue JM, Berard E, Rolland Y, Molinier L. Cost of care pathways before and after appropriate and inappropriate transfers to the emergency department among nursing home residents: results from the FINE study. BMC Geriatr. 2024 Apr 19;24(1):353. doi: 10.1186/s12877-024-04946-x.

Reference Type: DERIVED

PMID: 38641801 (View on PubMed)

Other Identifiers

2015-A00723-46

Identifier Type: OTHER

Identifier Source: secondary_id

RC31/15/7464

Identifier Type: -

Identifier Source: org_study_id