Hospital
Conditions
Keywords
clinical competence, digital health, education, hospital at home, hospital in the home, implementation, telemedicine
Brief summary
To enhance implementation of Hospital-at-home (HaH) in Scandinavia, the Nordic Digital Health & Education (NorDigHE) project has developed a comprehensive virtual education on HaH for clinical staff. The goal of this clinical trial is to evaluate whether an online education for clinical staff can enhance the implementation of HaH services in hospitals across Denmark, Norway, and Sweden. The primary outcome of the RCT is HaH implementation measured at organization level, understood as a change in clinical practice by increased HaH activity. Secondary outcomes are HaH knowledge and motivation among clinical staff as well as patient days in hospital, days hospitalized at home, 30-day readmission, and mortality. Researchers will compare hospitals receiving the NorDigHE education (intervention group) to hospitals continuing treatment as usual (control group) to see if the education leads to greater adoption of HaH and changes in service delivery. Participants will: * Complete baseline, 3-month, and 6-month surveys assessing HaH activity, staff knowledge, and motivation. * Participate in a 12-month follow-up assessment (intervention group only). * Be invited (patients, staff, and management) to take part in semi-structured interviews to share experiences and preferences related to HaH. * (For staff in the intervention group) Complete the NorDigHE virtual education program embedded in the WHO Fast-IM. After the study, the control group will be offered access to the NorDigHE education as a participant retention measure.
Detailed description
Background: In response to increasing pressures on healthcare systems due to aging populations, and increasing shortages of clinical staff, increased use of digital service designs has been recommended by most governments in Scandinavian and European countries. Virtually supported Hospital-at-Home (HaH) models, delivering acute hospital services in-home have been shown to be both feasible and beneficial. Nevertheless, implementation and scaling barriers are major challenges. To enhance implementation of HaH in Scandinavia, the Nordic Digital Health & Education (NorDigHE) project has developed a compre-hensive virtual education on HaH for clinical staff. The present study aims to evaluate the implementation impact of the NorDigHE education embedded in the WHO Fast-track Implementation Model (WHO Fast-IM). Methods and analysis: We use a randomized design and nested qualitative studies to meet the aim. Via open-call, hospitals will be recruited in Denmark, Norway, and Sweden and randomized to either receive the education embedded in the WHO Fast-IM or to continue treatment as usual. The primary outcome of the RCT is HaH implementation measured at organization level, understood as a change in clinical practice by increased HaH activity. Secondary outcomes are HaH knowledge and motivation among clinical staff as well as patient days in hospital, days hospitalized at home, 30-day readmission, and mortality. Data are collected at baseline, after 3, and 6 months. A 12-month maintenance measurement is performed in the intervention group. Post-study, the control group is offered the NorDigHE education as a participant re-tention measure. In addition, the attitudes, experiences, and preferences of HaH among patients, clinical staff, and management are collected via nested semi-structured interviews.
Interventions
BEHAVIORALHaH education
The intervention consists of the online NorDigHE HaH education with tailored implementation tools em-bedded in the WHO Fast-IM. The education is delivered online and asynchronously, combining e-learning, simulations, reflection exercises, and practical task training. The trial has adopted the evidence-based WHO Fast-track Implementation Model (WHO Fast-IM) as a framework to support the effectiveness and reporting of the implementation, and the tailored implementation tools embedded in the model will be provided as part of the intervention to support in-tegration into daily clinical routines. The tailored toolbox consists of workshops, introductory meetings, written guides, and access to a hotline staffed by project specialists to facilitate implementation.
Sponsors
Sahlgrenska University Hospital
Lund University
University College Copenhagen
Ostfold University College
Region Capital Denmark
Nordsjaellands Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Intervention model description
The study is designed as a two-armed, multicenter, superiority, cluster-randomized clinical trial with the hospital as the unit of randomization. The participating hospitals will autonomously select the relevant clinical departments and related staff to undergo the education tested. Data are collected at baseline, after 3, and 6 months. The intervention group also collects a 12-month maintenance assessment.
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
Hospitals with clinical departments treating acutely ill in-patients that have, or are ready to establish, the prerequisites and infrastructure for HaH - regardless of the specific approach, envisioned HaH model, primary sector collaborations, or local sector collaboration agreements and frameworks. Each hospital must have or be ready to establish: 1. a governance structure to organize and oversee HaH-services. 2. an IT-platform capable of managing data from and to HaH patients. 3. a safe communication pathway between HaH-patient and the hospital. 4. clear agreements on types of data to be exchanged between HaH-patient and hospital. 5. agreements on roles, responsibilities, and capacity (incl. possibly primary sector entities). 6. clinical guidelines, standard operating procedures, and action plans to support the HaH work.
Exclusion criteria
* Hospitals that do not have or are not ready to secure relevant pre-requisites listed above (a to f).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HaH implementation | From enrollment until 6 months follow-up measurement | The primary outcome, HaH implementation at the organizational level, is defined as a change in clinical practice, measured by the proportion of eligible patients who receive HaH. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Staff's motivation | From enrollment until 6 months follow-up | Staff's motivation to work with HaH. Staff HaH motivation is measured by Intrinsic Motivation Inventory (IMI) Scale questionnaires. Participants will be presented with a series of statements and asked to indicate how true each statement is for them on a 7-point scale, where 1 represents 'not true at all' and 7 represents 'very true'. |
| Staff's knowledge | From enrollment until 6 months follow-up | Staff members' knowledge on HaH. Staff's knowledge is collected as pre- and post-education questionnaires at baseline and at 6 months follow-up. The knowledge questionnaires have been developed prior to the study and has undergone pilot-validation with healthcare students, clinical staff, and education sector experts as part of the NorDigHE project. |
| Days hospitalized at home | From enrollment until 6 months follow-up | Length of stay while hospitalized at home versus in the hospital. Measured using registry data for patients admitted to the department during trial. |
| 30-day readmission | From enrollment until 6 months follow-up | The percentage of patients that readmit to the hospital within 30 days with the same illness they were previously discharged. Measured using registry data for patients admitted to the department during the trial. |
| Mortality | From enrollment until 6 months follow-up | Tthe number of deaths in participating hospitals (and their departments) during the trial (death rate) |
Countries
Denmark, Norway, Sweden
Contacts
Primary ContactMie H Martinussen
Backup ContactJeff K Svane
Outcome results
None listed