NCT02677272

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.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
1,040

participants targeted

Target at P75+ for all trials

Timeline
Completed

Started Jan 2016

Typical duration for all trials

Geographic Reach
1 country

16 active sites

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

January 1, 2016

Completed
7 days until next milestone

First Submitted

Initial submission to the registry

January 8, 2016

Completed
1 month until next milestone

First Posted

Study publicly available on registry

February 9, 2016

Completed
2.5 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

July 31, 2018

Completed
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

July 31, 2018

Completed
Last Updated

February 23, 2024

Status Verified

February 1, 2024

Enrollment Period

2.6 years

First QC Date

January 8, 2016

Last Update Submit

February 21, 2024

Conditions

Frail Elderly

Keywords

Nursing homeemergency departmentinappropriate transferelderly

Outcome Measures

Primary Outcomes (1)

  • Inappropriate transfer to ED of NH residents

    Inappropriateness of the NH residents' transfers to ED : the inappropriateness of ED transfers will be determined by the opinion of a group of experts composed of geriatricians, emergency physicians, general practitioners and pharmacists. Inappropriate transfer to ED is defined by the absence of somatic emergency and / or palliative care known before decision to transfer 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 transition to ED without loss of opportunity for the resident. To judge the inappropriateness of the transfer to ED, the group of experts will use a rating scale of usual emergencies. Individual and independent rating divergences will lead to a concerted evaluation of the clinical situation by the group. Analyse retro-prospectively by the group of experts.

    Baseline (T1 = inclusion at ED): retro-prospectively by the group of experts

Secondary Outcomes (4)

  • Cost of the NH resident transfer to ED

    6 months before to 6 months after the transfer

  • Avoidability of the NH resident transfer to ED

    Baseline (T1 = inclusion at ED)

  • NH resident's autonomy using Katz'ADL

    Change at different time points: T0, T2 (up to 12 days,if concerned) and T3 (7 days after return to NH)

  • Analysis of Medical prescription, with a focus on psychotropic drug

    Change at different time points: T1 (baseline), T2 (up to 12 days,if concerned) and T3 (7 days after return to NH)

Interventions

Appropriateness of NH resident's transfer to EDOTHER

Eligibility Criteria

Sexall
Healthy VolunteersNo
Age GroupsChild (0-17), Adult (18-64), Older Adult (65+)
Sampling MethodNon-Probability Sample
Study Population

All patients living in Nursing Home admitted in Emergency Department of the hospitals participating in the study during the inclusion period will be included in the study.

You may qualify if:

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

You may not qualify if:

  • 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

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (16)

CH d'Albi

Albi, France

Location

CH d'Auch

Auch, France

Location

CH de Cahors

Cahors, France

Location

CHI Castres Mazamet

Castres, France

Location

CH Ariège Couserans

Foix, France

Location

CH de Gourdon

Gourdon, France

Location

CH Lannemezan

Lannemezan, France

Location

CH Lavaur

Lavaur, France

Location

CH de Lourdes

Lourdes, France

Location

CH Castelsarrasin Moissac

Moissac, France

Location

CH Montauban

Montauban, France

Location

CH Rodez

Rodez, France

Location

CH Saint Gaudens

Saint-Gaudens, France

Location

CHI Val d'Ariège

Saint-Girons, France

Location

Toulouse University Hospital (CHU de Toulouse)

Toulouse, 31059, France

Location

CH de Bigorre

Vic-en-Bigorre, France

Location

Related Publications (5)

  • 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.

    PMID: 29696189BACKGROUND

  • 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.

    PMID: 33964225RESULT

  • 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.

    PMID: 38159914RESULT

  • 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.

    PMID: 34652784RESULT

  • 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.

    PMID: 38641801DERIVED

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease AttributesPathologic ProcessesPathological Conditions, Signs and Symptoms

Study Officials

  • Yves ROLLAND, MD PhD

    University Hospital, Toulouse

    PRINCIPAL INVESTIGATOR

Study Design

Study Type
observational
Observational Model
CASE ONLY
Time Perspective
RETROSPECTIVE
Sponsor Type
OTHER
Responsible Party
SPONSOR

Study Record Dates

First Submitted

January 8, 2016

First Posted

February 9, 2016

Study Start

January 1, 2016

Primary Completion

July 31, 2018

Study Completion

July 31, 2018

Last Updated

February 23, 2024

Record last verified: 2024-02

Data Sharing

IPD Sharing
Will not share

Locations

FR(16)