Efficacy of Integrated Care to Reduce Hospitalization and Nursing Home Placement in Community Dwelling Frail Elderly

NCT02084108 | Completed

• 1 other identifier: 08-128 and 08-06
• Study Type: interventional
• Target: 301
• Locations: 1 country
• Sites: 1

Brief Summary

Introduction: Care of frail and dependent elders with multiple chronic conditions is a major challenge for health care systems. The objective of this study is to evaluate the effect of coordinating the existing structures in the private and public sector for the care of frail and dependent persons over age 60, and susceptible of presenting complex bio-psycho-social issues. This approach is aimed at improving the coordination, continuity, quality and efficacy of care in this population, which presents a high risk of hospitalization, emergency room visits, institutionalization and mortality. Methods: Three-year cluster randomised controlled trial. A control group receiving usual care (follow up by primary care physician and home nursing service) will be compared to an intervention group that will be provided, in addition, in-home multidimensional geriatric assessment with access to a 24h/7 day a week call service, and coordinated long-term follow-up. Survival analyses will be conducted to compare the outcomes between groups. Primary outcome: \- Hospitalizations: rates of first hospitalization, number, cause and length of stay. Secondary outcomes:

• Emergency room visits: rates of first visit, number and cause
• Institutionalization: number of patients
• Mortality: rate and number of deaths and place of death (home versus hospital)

Conditions

Chronic Diseases

Keywords

Frail and dependent older adults; Integrated care; Home care; Multidimensional geriatric assessment; RAI-HC (resident assessment instrument- Home care); Palliative care.

Outcome Measures

Primary Outcomes (1)

• Hospitalizations: rates of first hospitalization, number and reason

  Three years

Secondary Outcomes (3)

• Emergency room visits: rates of first visit, number and cause.

  Three years

• Institutionalization: number of patients

  Three years

• Mortality: rate and number of deaths and place of death (home versus hospital)

  Three years

Study Arms (2)

Control arm= usual care

NO INTERVENTION

Two clusters of patients over 60 years of age followed by a primary care physician and routinely evaluated by the home nursing service with the resident assessment instrument-home care (RAI-HC) and identified as frail by pre-defined clinical criteria.

Intervention arm

OTHER

The intervention arm will consist of two clusters of patients over 60 years of age followed by a primary care physician and routinely evaluated by the home nursing service with the RAI-HC and identified as frail by predefined clinical criteria that will receive in addition an in-home multidimensional geriatric assessment, access 24 hours a day, 7 days a week to a call service provided by the Community Geriatrics Unit and coordinated long-term follow-up.

Other: intervention

Interventions

intervention OTHER

intervention group that will be provided, in addition, in-home multidimensional geriatric assessment with access to a 24h/7 day a week call service, and coordinated long-term follow-up.

Intervention arm

Eligibility Criteria

• Age: 60 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients followed by the home nursing service and primary care physician
• Over 60 years of age
• Able to give consent (patient or caregiver)
• Able to speak French
• Meeting frailty criteria as determined by one of the following alarms detected by the RAI-HC:
• Alarm 8: cognition
• Alarm 12: social role and function
• Alarm 15: falls
• Alarm 22: frailty of the informal care giver system.

You may not qualify if:

• Age under 60 years
• Unable (patient or caregiver) to give informed consent
• Unable to communicate adequately in French
• Patients' not receiving nursing visits (only receiving practical aid or services from occupational therapists).

Sponsors & Collaborators

• University Hospital, Geneva: lead

Study Sites (1)

University hospital of Geneva

Geneva, Canton of Geneva, 1211, Switzerland

Location

Related Publications (1)

• Di Pollina L, Guessous I, Petoud V, Combescure C, Buchs B, Schaller P, Kossovsky M, Gaspoz JM. Integrated care at home reduces unnecessary hospitalizations of community-dwelling frail older adults: a prospective controlled trial. BMC Geriatr. 2017 Feb 14;17(1):53. doi: 10.1186/s12877-017-0449-9.

  PMID: 28196486 DERIVED

MeSH Terms

Conditions

Chronic Disease

Interventions

Methods

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Investigative Techniques

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Doctor in medecin

Study Record Dates

• First Submitted: March 7, 2014
• First Posted: March 11, 2014
• Study Start: July 1, 2009
• Primary Completion: December 1, 2012
• Study Completion: December 1, 2012
• Last Updated: March 11, 2014

Record last verified: 2014-03

Locations

CH (1)