Dementia, Emergency Department Visit, Home Care Services
Conditions
Brief summary
The investigators will perform a parallel-group multicenter randomized controlled trial of a 1-year pre-enrolled acute hospital care at home intervention vs usual care for people living with dementia. Patients will be randomized only after eligibility determination and after the family caregiver agrees to enroll; people living with dementia will assent when able. Patients will be allocated in a concealed fashion to the control and intervention groups in randomly selected block sizes of 4 or 6 in 4 strata reflecting their functional status (activities of daily living: 0, 1, 2-3, 4-6). Although family and clinicians cannot be blinded, the investigators will blind the data collectors and assessors.
Interventions
OTHERAcute hospital care at home
Home visit for a serious illness conversation. Acute illness evaluation on demand. Acute hospital care at home as needed.
OTHERStandard medical treatment
Standard acute and emergency care delivered in a brick-and-mortar hospital setting.
Sponsors
Brigham and Women's Hospital
National Institute on Aging (NIA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Data collectors
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of moderate or severe dementia (as ascertained by the Quick Dementia Rating System; QDRS) * Resides in a private or assisted living residence with or nearby (\<15min travel time) to a family caregiver * Resides within the Mass General Brigham (MGB) home hospital catchment area * Has had at least 1 hospitalization in the last 12 months.
Exclusion criteria
* Hospitalized in the last 30 days * No functioning utilities, such as no working heat (October-April), no running water, or no electricity. * Resides in skilled nursing facility * Resides in group home * Domestic violence screen positive * In police custody * Family caregiver unable to initiate or maintain communication with care team * End-stage renal disease on hemodialysis * On methadone requiring daily pickup of medication * Active substance use disorder, without functioning treatment plan * Psychiatric diagnosis that would prohibit successful home hospital care * Acute delirium without explanation or without the ability to manage at home * Patients with cancer requiring consistent hospital-based treatments * Cannot ambulate to bedside commode with assistance present in the home (if different from baseline), unless home-based aides are available
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of days at home | Discharge to 30-days post discharge, up to 30 days | Sum of the number of days spent at home within the 30-days after an acute care episode |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 30-day unplanned readmission or mortality | Discharge to 30-days post discharge, up to 30 days | Percentage of unplanned readmissions or mortality |
| Delirium | Date of admission to date of discharge, estimated 5 days | Percentage of days experiencing delirium while receiving acute care using the short confusion assessment method. |
| Health-related quality of life | From enrollment for the period of one year | Absolute change of health-related quality of life over the year through the dementia quality of life survey (DEMQOL), or for patients unable to complete the survey, its proxy version (DEMQOL-Proxy). |
| Physical activity | Date of admission to date of discharge, estimated 5 days | Percent of time sedentary as measured by patch monitoring system. |
Countries
United States
Contacts
CONTACTDavid M Levine, MD, MPH, MA
CONTACTFernando Chavarria, MD, MSc
Outcome results
None listed