The LEARNING WISDOM Phase II Scale up Project

NCT ID: NCT04093245

Last Updated: 2019-11-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

4000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-01-21

Study Completion Date

2022-12-31

Brief Summary

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Inspired by the Acute Care for Elders program at Mount Sinai Hospital, this study aims to improve care for elderly patients in four hospitals of Chaudière-Appalaches. Focusing on improving transitions between hospital and the community, this project will help professionals to adapt best practices to local context in transition of care for the elderly.

Detailed Description

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Background: Elderly patients discharged from hospital currently experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital uses innovative strategies such as transition coaches, follow-up calls and patient self-care guides to improve the care transition experiences of the frail elderly patients from hospitals to the community. The ACE program reduced lengths of hospital stay and readmissions for elderly patients, increased patient satisfaction, and saved the healthcare system over $6 million in 2014.

In 2016, the ACE program was implemented at one hospital in the Centre intégré en santé et en services sociaux de Chaudière-Appalaches (CISSS CA), a large integrated healthcare organization in Quebec, with a focus on improving transitions between hospital and the community for the elderly. This project used rapid, iterative user-centered design prototyping and a "Wiki-suite" (a free online database containing evidence-based knowledge tools in all areas of healthcare and an accompanying training course) to engage multiple stakeholders including a patient partner to improve care for elderly patients. Within this one year project, the investigators developed a context-adapted ACE intervention with the support of the Mt. Sinai Hospital, the Canadian Foundation for Healthcare Improvement and the Canadian Frailty Network.

The goal is to scale up the ACE program for elderly care transition to three new hospital sites within the CISSS CA, using the Wiki-suite to allow for further context-adaptation of the program in these new hospitals.

Objectives: 1) Implement a context-adapted ACE program in three hospitals in the CISSS CA and measure its impact on patient, caregiver, clinical and hospital-level outcomes; 2) Identify underlying mechanisms by which the context-adapted ACE program improves care transitions for the elderly; 3) Identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools.

Methods: Objective 1: Staggered implementation of the ACE program across the three CISSS CA sites; interrupted time series to measure the impact on hospital-level outcomes; pre/post cohort study to measure the impact of the new program on patient, caregiver and clinical outcomes. Objectives 2 and 3: Parallel mixed-methods process evaluation study to understand the mechanisms by which the context-adapted ACE program improves care transitions for the elderly and by which the Wiki-suite contributes to adaptation, implementation and scaling up of geriatric knowledge tools.

Expected results: This project will provide much needed evidence on effective Knowledge Translation (KT) strategies to adapt best practices to local context in transition of care for the elderly. It will contribute to adapting geriatric knowledge to local contexts. The knowledge generated through this project will support future scale-up of the ACE program and the wiki methodology to other settings in Canada.

Conditions

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Transition Emergencies Health Care Utilization Frailty

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Phase I-A (Local project set-up)

An executive committee will oversee the entire project. This committee, led by the nominated PI and Director of Nursing, will meet every 4 weeks during this four-year project. The team may include, depending on the hospital site: an administrator, the ED Director, the ED Head nurse, a community and/or hospital-based geriatric nurse specialist, an ED physician, a hospitalist, a geriatrician, a family physician, a home care nurse/coordinator, an inpatient unit manager, the research coordinator, and a local patient/caregiver. Each local team will be responsible for selecting and implementing the ACE intervention(s) best suiting their milieu, and will include locally identified champions to lead the local implementation.

Group Type NO_INTERVENTION

No interventions assigned to this group

Phase I-B (Implementation):

The investigators will implement the context-adapted ACE program with the support of administrators and local implementation teams who will have the responsibility to roll out the different elements of the intervention within their respective hospitals. It may include a series of systematic pre-discharge, post-discharge and across transitions period interventions for eligible patients: 1) a GEM nurse to support patients during the post-discharge transition period, 2) pre- and post-hospitalization medication list reconciliation, 3) systematic discharge summaries given to patients and/or caregiver, and sent to their family physician, 4) a planned follow-up appointment with their family physician, 5) a systematic follow-up phone call, 6) access to wiki-based patient-oriented KT tools, 7) access to a community-based telemonitoring service.

Group Type EXPERIMENTAL

GEM nurse

Intervention Type BEHAVIORAL

hospital-based geriatric emergency nurse (GEM nurse) specialist to support patients during the post-discharge transition period

pre- and post-hospitalization medication list reconciliation

Intervention Type BEHAVIORAL

pre- and post-hospitalization medication list reconciliation for elderly

systematic discharge summaries

Intervention Type BEHAVIORAL

systematic discharge summaries given to patients and/or caregiver, and sent to their family physician

medical follow-up appointment

Intervention Type BEHAVIORAL

a planned follow-up appointment with their family physician

follow-up phone call

Intervention Type BEHAVIORAL

a systematic follow-up phone call for discharged patients

Wiki-based Knowledge tools

Intervention Type OTHER

access to wiki-based patient-oriented KT tools

Telemonitoring service

Intervention Type OTHER

access to a community-based telemonitoring service

Phase IC (Study description)

Results from each center will be analysed over time. Guided by previous work in healthcare governance, the investigators will analyze the impact of the sequential interventions within the context of a major health reform in Quebec aiming at implementing an integrated health system and within the PI program's overall goal of creating a Learning Health System. This will be accomplished by conducting a comparative case study across the four study sites to compare the barriers, facilitators and local solutions implemented to gain a better understanding about how the ACE program could eventually be scaled up elsewhere.

Group Type EXPERIMENTAL

GEM nurse

Intervention Type BEHAVIORAL

hospital-based geriatric emergency nurse (GEM nurse) specialist to support patients during the post-discharge transition period

pre- and post-hospitalization medication list reconciliation

Intervention Type BEHAVIORAL

pre- and post-hospitalization medication list reconciliation for elderly

systematic discharge summaries

Intervention Type BEHAVIORAL

systematic discharge summaries given to patients and/or caregiver, and sent to their family physician

medical follow-up appointment

Intervention Type BEHAVIORAL

a planned follow-up appointment with their family physician

follow-up phone call

Intervention Type BEHAVIORAL

a systematic follow-up phone call for discharged patients

Wiki-based Knowledge tools

Intervention Type OTHER

access to wiki-based patient-oriented KT tools

Telemonitoring service

Intervention Type OTHER

access to a community-based telemonitoring service

Interventions

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GEM nurse

hospital-based geriatric emergency nurse (GEM nurse) specialist to support patients during the post-discharge transition period

Intervention Type BEHAVIORAL

pre- and post-hospitalization medication list reconciliation

pre- and post-hospitalization medication list reconciliation for elderly

Intervention Type BEHAVIORAL

systematic discharge summaries

systematic discharge summaries given to patients and/or caregiver, and sent to their family physician

Intervention Type BEHAVIORAL

medical follow-up appointment

a planned follow-up appointment with their family physician

Intervention Type BEHAVIORAL

follow-up phone call

a systematic follow-up phone call for discharged patients

Intervention Type BEHAVIORAL

Wiki-based Knowledge tools

access to wiki-based patient-oriented KT tools

Intervention Type OTHER

Telemonitoring service

access to a community-based telemonitoring service

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Eligible patients will be:

* aged ≥ 65 years
* be discharged from the ED
* able to understand and read French
* able to give informed consent

Eligible caregivers will be:

* identified by the patients themselves
* able to understand and read French
* able to give informed consent

Exclusion Criteria

\-
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Laval University

OTHER

Sponsor Role lead

Responsible Party

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Patrick Archambault

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Patrick M Archambault, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Laval University

Locations

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Centres intégrés de santé et de services sociaux (CISSS) De Chaudières-Appalaches

Lévis, Quebec, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Patrick M Archambault, MD, MSc

Role: CONTACT

4188357121 ext. 3905

Pascal Y Smith, PhD

Role: CONTACT

4188357121 ext. 4548

Facility Contacts

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Pascal Y Smith, PhD

Role: primary

References

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Related Links

Access external resources that provide additional context or updates about the study.

http://www.statcan.gc.ca/daily-quotidien/150929/dq150929b-eng.htm

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Grol R, Wensing M, Eccles M, Davis D. Improving Patient Care: The Implementation of Change in Health Care \[Internet\]. Wiley-Blackwell; 2013

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

Learning Wisdom 2018-462

Identifier Type: -

Identifier Source: org_study_id

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