The LEARNING WISDOM Phase II Scale up Project

NCT04093245 | Unknown

• 1 other identifier: Learning Wisdom 2018-462
• Study Type: interventional
• Target: 4,000
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Transition; Emergencies; Health Care Utilization; Frailty

Keywords

Emergency Department; Care Transition; Elderly Frailty

Outcome Measures

Primary Outcomes (2)

• Change of 30-day hospital readmission

  Composite endpoint at each month 30-day hospital readmission

  each month during 4 years (48)

• Change of 30-day ED visit rate

  Composite endpoint at each month 30-day ED visit rate

  each month during 4 years (48)

Secondary Outcomes (15)

• 1- change Hospital/ED length of stay - Hospital-level outcome

  Each month during 4 years (48)

• 2- change ED admission rate - Hospital-level outcome

  Each month during 4 years (48)

• 3- Change Alternate level care occupation rate- Hospital-level outcome

  Each month during 4 years (48)

• 4- Change Rate of patients returning to pre-hospital living situation- Hospital-level outcome

  Each month during 4 years (48)

• Clinicians and decision maker outcomes (Qualitative outcome)

  each 3 months, during 4 years (12)

Study Arms (3)

Phase I-A (Local project set-up)

NO INTERVENTION

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.

Phase I-B (Implementation):

EXPERIMENTAL

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.

Behavioral: GEM nurse; Behavioral: pre- and post-hospitalization medication list reconciliation; Behavioral: systematic discharge summaries; Behavioral: medical follow-up appointment; Behavioral: follow-up phone call; Other: Wiki-based Knowledge tools; Other: Telemonitoring service

Phase IC (Study description)

EXPERIMENTAL

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.

Behavioral: GEM nurse; Behavioral: pre- and post-hospitalization medication list reconciliation; Behavioral: systematic discharge summaries; Behavioral: medical follow-up appointment; Behavioral: follow-up phone call; Other: Wiki-based Knowledge tools; Other: Telemonitoring service

Interventions

GEM nurse BEHAVIORAL

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

Phase I-B (Implementation):; Phase IC (Study description)

pre- and post-hospitalization medication list reconciliation BEHAVIORAL

pre- and post-hospitalization medication list reconciliation for elderly

Phase I-B (Implementation):; Phase IC (Study description)

systematic discharge summaries BEHAVIORAL

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

Phase I-B (Implementation):; Phase IC (Study description)

medical follow-up appointment BEHAVIORAL

a planned follow-up appointment with their family physician

Phase I-B (Implementation):; Phase IC (Study description)

follow-up phone call BEHAVIORAL

a systematic follow-up phone call for discharged patients

Phase I-B (Implementation):; Phase IC (Study description)

Wiki-based Knowledge tools OTHER

access to wiki-based patient-oriented KT tools

Phase I-B (Implementation):; Phase IC (Study description)

Telemonitoring service OTHER

access to a community-based telemonitoring service

Phase I-B (Implementation):; Phase IC (Study description)

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• 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

Sponsors & Collaborators

• Laval University: lead

Study Sites (1)

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

Lévis, Quebec, G6V 3Z1, Canada

RECRUITING

Related Publications (86)

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MeSH Terms

Conditions

Emergencies; Patient Acceptance of Health Care; Frailty

Interventions

Lead

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Treatment Adherence and Compliance; Health Behavior; Behavior

Intervention Hierarchy (Ancestors)

Metals, Heavy; Elements; Inorganic Chemicals; Metals

Study Officials

• Patrick M Archambault, MD, MSc

  Laval University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Patrick M Archambault, MD, MSc

CONTACT

4188357121; patrick.m.archambault@gmail.com

Pascal Y Smith, PhD

CONTACT

4188357121; pascalysmith65@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: September 9, 2019
• First Posted: September 17, 2019
• Study Start: January 21, 2019
• Primary Completion: December 31, 2021
• Study Completion: December 31, 2022
• Last Updated: November 5, 2019

Record last verified: 2019-11

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)