Condition 1: Congestive Heart Failure. Condition 2: Coronary Artery Disease. Condition 3: Hypertension. Condition 4: Cardiac Arrhythmia. Condition 5: Chronic Obstructive Pulmonary Disease. Condition 6: Diabetes. Condition 7: Peripheral Vascular Disease. Chronic combined systolic (congestive) and diastolic (congestive) heart failure Atherosclerotic heart disease of native coronary artery Chronic venous hypertension (idiopathic) Cardiac arrhythmia, unspecified Chronic obstructive pulmonary di
Conditions
Interventions
Intervention 1: Experimental group: The intervention in the experimental group is based on the care transition intervention model, which is the duration of the intervention from the time of admission
Sponsors
Faculty of Medical Sciences, Tarbiat Modares University
Eligibility
Sex/Gender
All
Age
60 Years to No maximum
Inclusion criteria
Inclusion criteria: Age 60 years and older Alertness and ability to communicate Having a normal cognitive status based on the Abbreviated Mental Test (score 7 and above) Having at least two chronic condition (Congestive Heart Failure, Coronary Artery Disease, Hypertension, Cardiac Arrhythmia, Chronic Obstructive Pulmonary Disease, Diabetes, Peripheral Vascular Disease) Having a telephone Being transported home after hospital discharge Family caregivers must be at least Be 18 years old Willingness to continue participating in the study
Exclusion criteria
Exclusion criteria: Evidence of mental illness and dementia
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Rehospitalization. Timepoint: The beginning of the study (Before intervention), 30, 90 and 180 days after discharge. Method of measurement: Questionnaire. | — |
Secondary
| Measure | Time frame |
|---|---|
| Quality of Life. Timepoint: The beginning of the study (Before intervention), 30, 90 and 180 days after discharge. Method of measurement: World Health Organization Quality of Life Questionnaire, older adults Edition.;Activity of Daily Living. Timepoint: The beginning of the study (Before intervention), 30, 90 and 180 days after discharge. Method of measurement: Activities of Daily Living Questionnaire.;Instrumental Activity of Daily Living. Timepoint: The beginning of the study (Before intervention), 30, 90 and 180 days after discharge. Method of measurement: Instrumental Activity of Daily Living Questionnaire.;Depression. Timepoint: The beginning of the study (Before intervention), 30, 90 and 180 days after discharge. Method of measurement: Geriatric Depression Scale. | — |
Countries
Iran (Islamic Republic of)
Contacts
Public ContactDr. Eesa Mohammadi
Faculty of Medical Sciences, Tarbiat Modares University
Outcome results
None listed