Effect of a Transitional Care Intervention

NCT ID: NCT04796701

Last Updated: 2021-11-04

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

COMPLETED

Clinical Phase

NA

Total Enrollment

1266 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-02-01

Study Completion Date

2019-12-31

Brief Summary

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The objective of this study is to evaluate the effect of a transitional care intervention on readmissions among older medical patients.

The proportion of older people is rapidly growing. These changes represent a challenge for healthcare systems. 20% of all hospital admitted patients ≥ 65 years are readmitted within the first 30 days after discharge. Prior transitional care research has mainly focused on either hospital-based or community-based interventions with no or little intervention elements in both settings. The results show different effects on readmission rates. This calls for new research on trans-sectorial interventions with both pre- and post-discharge elements.

Detailed Description

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Design:

Non-randomized controlled trial.

Participants For eligibility criteria - see elsewhere. Intervention group • Patients living in Odder, Skanderborg or Hedensted municipality

Control group

• Patients living in Horsens municipality

Follow-Home Intervention

The intervention group receives following intervention:

If possible, all included participants are physically followed home by a hospital-based project worker on the day of discharge. During the visit, the focus is on: basic human needs, medication review reconciliation, and a comprehensive geriatric assessment. Problems, challenges and concerns are discussed. Finally, a conference for the following working day is arranged either as a physical visit or a video conference. The patient, relatives, community-based nurse and project worker are invited to participate and health status and challenges are discussed They are recommended to contact the project worker about health and practical issues up to 7 days after discharge where the intervention ends. Subsequently, the responsibility for treatment and care is assigned to the GP and home healthcare provider.

Usual care

Patients in the control group recieves the following usual discharge procedure:

On the day of discharge, the hospital-based nurse digitally sends a summery of the hospital stay and a treatment and care plan to the community-based nurse. If needed, the hospital-based nurse contacts the community-based nurse by phone as a supplement to the plan. Finally, a discharge letter conducted by the hospital-based doctor is digitally sent to the GP.

Method:

Inclusion of participants is consecutive. Inclusion period was between 01/02/17 to 31/12/19. In total, approximately 1200 patients were included .

Data collection Outcome data will be retrieved from CROSS-TRACKS database at 30 days after discharge from index admission.

Analysis

Intervention and Control group will be matched on 3 variables on individual level:

* CCI
* Index admission period: +/- 3-4 weeks
* Sex

All readmissions are included in the analysis (not only first time readmissions). That means that one patient can be included several times.

Logistic regression adjusted for possible confounders will be used when analysing the outcomes. Confounders are chosen through a study specific DAG.

Sub-group analysis will be conducted according to:

* Age
* Sex
* Housing
* Civil status
* Social status
* Length of hospital stay in index admission
* Comorbidity
* Diagnosis
* Ect.

Conditions

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Frailty

Keywords

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readmission transitional care discharge older medical patients

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Non-randomized controlled trial
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Intervention group: living in three predefined municipality Control group: living in one predefined municipality

Study Groups

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Follow Home Intervention

If possible, all included participants are physically followed home by a hospital-based project worker on the day of discharge. During the visit, the focus is on: basic human needs, medication review reconciliation, and a comprehensive geriatric assessment. Problems, challenges and concerns are discussed. Finally, a conference for the following working day is arranged either as a physical visit or a video conference. The patient, relatives, community-based nurse and project worker are invited to participate and health status and challenges are discussed They are recommended to contact the project worker about health and practical issues up to 7 days after discharge where the intervention ends. Subsequently, the responsibility for treatment and care is assigned to the GP and home healthcare provider.

Group Type EXPERIMENTAL

Follow-Home-intervention

Intervention Type OTHER

x

Control

On the day of discharge, the hospital-based nurse digitally sends a summary of the hospital stay and a treatment and care plan to the community-based nurse. If needed, the hospital-based nurse contacts the community-based nurse by phone as a supplement to the plan. Finally, a discharge letter conducted by the hospital-based doctor is digitally sent to the GP

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Follow-Home-intervention

x

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients aged ≥75 years
* Living in the municipalities of Odder, Skanderborg, Hedensted or Horsens
* Admitted for ≥48 hours
* Discharged from Medical Ward 1 (MSA1) at Horsens Regional Hospital (HRH)

Exclusion Criteria

* Terminally ill patients
* Patients with cerebrovascular events
* Readmitted to another hospital
* Not able to speak and understand Danish
Minimum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Aarhus

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Merete Gregersen, PHD

Role: STUDY_CHAIR

Aarhus University Hospital

Locations

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Horsens Regional Hospital

Horsens, , Denmark

Site Status

Countries

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Denmark

References

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Rasmussen LF, Barat I, Riis AH, Gregersen M, Grode L. Effects of a transitional care intervention on readmission among older medical inpatients: a quasi-experimental study. Eur Geriatr Med. 2023 Feb;14(1):131-144. doi: 10.1007/s41999-022-00730-5. Epub 2022 Dec 23.

Reference Type DERIVED
PMID: 36564644 (View on PubMed)

Other Identifiers

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FH2017-2019

Identifier Type: -

Identifier Source: org_study_id