Utilization of Medical Care by Nursing Home Residents
Conditions
Keywords
nursing home residents, interprofessional collaboration, reduction of hospitalisation
Brief summary
Previously,six measures were developed for a better collaboration of general practitioners and nurses in nursing homes in a qualitative multistep bottom-up process. These measures, summarised as the interprof ACT intervention, shall improve the flow of information and the communication between the involved parties and lead to more transparency and effectiveness regarding treatment decisions of nursing home residents.The major aim of this trial is to examine the clinical effectiveness of interprof ACT. The main hypothesis is that implementation of interprof ACT reduces the cumulative incidence of hospitalisations of nursing home residents within 12 months from 50% to 35% (15% absolute reduction).
Interventions
PROCEDUREinterprof ACT measures
Definition of common goals between general practitioner and nursing staff, appointment of a contact person, support in assigning medication, use of name badges worn by GPs and nurses during visits, mandatory availability of contact person, standardized procedures for GPs home visits
Sponsors
University Medical Center Goettingen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
Blinded study nurses with respect of primary outcome.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Residents: * at least one GP visit in recent three months or * two GP visits in recent 6 months or * admission to the nursing home during the precedent 6 months independently of documented GP contacts * at least 18 years of age * written informed consent by the resident or her/his legal guardian Inclusion Criteria Nursing Homes: * minimum size of 40 residents * written consent provided by the nursing home Manager Prior to randomisation
Exclusion criteria
Residents: \- admission for short term care only
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| cumulative number of hospitalisation | within 12 months | Cumulative incidence of hospitalisations from nursing home residents within 12 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| hospital days | within 12 months | Hospital days within 12 months |
| mortality | within 12 months | mortality within 12 months |
| potentially inadequate medications | baseline and after 6 and 12 months | potentially inadequate medications at baseline and for follow-ups at 6 and 12 months |
| Adverse Events | within 12 months | Adverse Events within 12 months |
| Quality of Life in Alzheimer's Disease scale - Nursing Home version (QoL-AD-NH) | baseline and after 12 months | Residents' quality of life at baseline and at 12 months. Scale range is 15 - 60, with higher scores indicating higher QoL. |
| absolute number of hospitalisations | within 12 months | number of hospitalisations within 12 months |
| medical services | within 12 months | use of other medical services within 12 months |
| economic evaluation: efficiency | after 12 months | economic evaluation: efficiency (incremental cost-effectiveness ratio) and cost savings from payer and societal perspective |
| Quality of inter-professional collaboration according to the Partnership Self-Assessment Tool (PSAT) score | after 12 months | Higher score values indicating better collaboration. |
| Attitudes towards inter-professional collaboration according to the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAPNC) score | after 12 months | Higher score values indicating more favourable attitudes. |
| Health-related Quality of Life (HRQL) of residents measured by EQ-5D-5L | baseline and after 12 months | The EQ-5D-5L consist of two self-rating components: the EQ-5D descriptive system and a visual analogue scale (EQ VAS). The EQ-5D descriptive system measures HRQL on the five dimensions mobility, self-care, usual activities, pain / discomfort and anxiety / depression. On each dimension participants can rate either no problems (0), slight problems (1), moderate problems (2), severe problems (3) or extreme problems (4), resulting in a score ranging from 0 (best) to 4 (worst). The scores of the single dimensions can be combined to a sum score ranging from 0 (best) to 20 (worst). In addition, so called utility weights can be attached to any possible combination of answers on the EQ-5D descriptive system which results in a utility score ranging from 0 (death) to 1 (full HRQL), which is then used to calculate quality-adjusted life years (QALYs). The EQ VAS ranges from 0 (worst imaginable health state) to 100 (best imaginable health state). |
Countries
Germany
Outcome results
None listed