Complex care needs of residents in long-term care facilities
Conditions
Interventions
Group 1: The intervention consists of the implementation of a role profile for nurses with expanded competencies in person-centred care in long-term care. Intervention components will be resident-rela
Sponsors
Universität zu Lübeck, Institut für Sozialmedizin und Epidemiologie, Sektion für Forschung und Lehre in der Pflege
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: (High level of care dependency: German grade 3) OR ((medium level of care dependency: German grade 2) AND ((multimorbidity: three or more chronic illnesses) OR (at least one unplanned emergency service use: out-of-hour, emergency transport, emergency room or hospitalisation in the previous 8 weeks)))
Exclusion criteria
Exclusion criteria: (Life expectancy less than six months) OR (resident or legal guardian unable to understand study information in german language)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Hospital stays of nursing home residents (number, kind of admissions (elective versus unplanned), length of stay in days, reason for admission, initiation by whom, discharge diagnosis) will be copied from the digital resident record of nursing homes retrospectively at three time points (t0: Baseline and randomisation, t1: t0 +3 months, t2: t0 + 6 months). | — |
Secondary
| Measure | Time frame |
|---|---|
| All outcomes extracted from residents’ digital records will be measured at three timepoints (t0: baseline and randomisation, t1: t0 +3 months, t2: t0 + 6 months) for three months retrospectively. Outcomes measured questionnaire-based with residents (or by proxy) will be collected at t0 and t2, according to the time-frame defined by the respective instrument. Distal outcomes will be: Out-of-hour physician contacts (number and kind of contact (e.g. visits, telephone calls), reasons for initiation and initiator); emergency service use (number and kinds of services used, initiator, reason for contact), as documented in the residents’ record; health related quality of life (EuroQol 5-dimension 5-level (EQ-5D-5L)), as self-reported by resident or proxy assessment by nursing staff. Proximal outcomes will be: Symptom burden (Four-dimensional symptom questionnaire (4DSQ), Self-care in chronic diseases (LTCQ-8-G), and Person-Centred Climate Questionnaire Patients (German version, PCQ-P-G) as reported by resident (no proxy assessment); Falls and fall-related injuries, pressure ulcer category 2 or higher, incontinence associated dermatitis, potentially inappropriate medication (using PRISCUS criteria), contacts with general practitioners (kind of contact, e.g. telephone, fax, visit; reason, initiator, planned versus unplanned), all extracted from residents’ digital record. Further outcomes (safety, harms) will be: all-cause mortality (date, reasons, t1 and t2 only), current level of care based on nursing care insurance act, extracted from residents’ digital record. Further outcomes on resource use will be: Other health care utilisation data (based on FIMA Questionnaire), extracted from residents’ digital record. A process evaluation will address implementation, change mechanisms and contextual factors of the intervention using predominantly qualitative methods (interviews, focus groups, observations) with nurses, residents and family if applicable. | — |
Countries
Germany
Contacts
Public ContactKatharina Silies
Universität zu Lübeck, Institut für Sozialmedizin und Epidemiologie, Sektion für Forschung und Lehre in der Pflege
Outcome results
None listed