Hospitalisation Prevention, Nursing Home Care
Conditions
Keywords
Nursing home, Geriatrics, Telemedicine, Hospitalisation, Mobile diagnostics
Brief summary
This prospective observational before-after study evaluates the impact of a Mobile Geriatric Unit (MGU) on hospitalisation rates among nursing home residents. The study includes a 12-month control phase with usual care followed by a 12-month intervention phase during which the MGU is implemented. The MGU provides advanced on-site diagnostics and telemedicine-supported specialist consultation within nursing homes.
Detailed description
This prospective observational before-after study evaluates the impact of a Mobile Geriatric Unit (MGU) on hospitalisation rates among nursing home residents in Saarland, Germany. The study includes a 12-month control phase with usual care followed by a 12-month intervention phase with MGU implementation in 46 nursing homes. The MGU provides on-site advanced diagnostics (CT, X-ray, ultrasound, ECG, EEG, and laboratory testing) supported by telemedicine consultation with hospital specialists. A physician and radiology technician perform diagnostics in the nursing home, with results communicated to the general practitioner for treatment decisions within 48 hours. Usual care involves hospital referral and in-hospital diagnostics. The intervention aims to reduce avoidable hospital admissions by providing diagnostics and specialist input directly in the nursing home. The primary outcome is hospital admissions per person-year. Secondary outcomes include mortality, functional and cognitive status, quality of life (EQ-5D-5L), complications, healthcare costs, and 30-day hospitalisation-free survival. Eligible participants are nursing home residents with consent or proxy consent; those requiring immediate hospitalisation are excluded. Data are obtained from routine care and medical records, MGU documentation, structured assessments, and follow-up. Multilevel Poisson regression and interrupted time series analysis will be used. The study was approved by the Ethics Committee of Saarland (AZ 159-21) and conducted in accordance with the Declaration of Helsinki.
Interventions
OTHERMobile Geriatric Unit (MGU)
The MGU is a mobile diagnostic unit providing on-site diagnostics in nursing homes. It includes a 32-slice (64 slice reconstruction) whole body CT scanner, digital X-ray, portable ultrasound, ECG, EEG, and point-of-care laboratory diagnostics. A physician and radiology technician perform diagnostics on-site. Results are transmitted via telemedicine to hospital specialists and communicated to the general practitioner for treatment decisions within 48 hours.
Sponsors
Universität des Saarlandes
DIKOM Consortium
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Residents of participating nursing homes * Informed consent from participant or legal representative
Exclusion criteria
* Acute life-threatening conditions requiring immediate hospitalisation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospital admissions per person-year | Up to 24 months | Number of inpatient hospital admissions, excluding elective admissions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mortality | Day 180 | Mortality |
| Functional status; mobility: modified Rankin Scale (mRS) | Day 180 | Modified Rankin Scale (mRS): 0: No symptoms 1. No significant disability 2. Slight disability 3. Moderate disability 4. Moderately severe disability 5. Severe disability 6. Death Minimum value: 0 (best outcome) Maximum value: 6 (worst outcome) |
| Functional status; frailty: Clinical Frailty Scale | Day 180 | Clinical Frailty Scale (as according to Moorhouse and Rockwood\*): 1. very fit 2. well 3. managing well 4. apparently vulnerable 5. mildly frail 6. moderately frail 7. severely frail 8. very severely frail 9. terminally ill Minimum value: 1 (best outcome) Maximum value: 9 (worst outcome) \* Moorhouse P, Rockwood K. Frailty and its quantitative clinical evaluation. J R Coll Physicians Edinb 2012; 42: 333-40 |
| Cognitive status | Day 180 | The cognitive performance assessment is carried out through subjective evaluation by the nursing home's nursing staff at day 180. |
| Quality of life (EQ-5D-5L) | Day 180 | EQ-5D-5L is a standardised measure of health-related quality of life developed by the EuroQol Group and assesses health status in terms of five dimensions of health. The five levels in each dimension are worded as (1) 'not /no problems', (2) 'slight problems', (3) 'moderate problems', (4) 'severe problems' and (5) 'unable to' (mobility, self-care, usual activities), 'extreme' (pain/depression), or 'extremely' (anxiety/depression). Minimum value: 1 (best outcome) Maximum value: 5 (worst outcome) |
| Healthcare costs | Day 360 | Hospitalisation, transport, and MGU costs |
| 30-day hospitalisation-free survival | Day 30 | Hospitalisation-free survival at day 30 |
Countries
Germany
Contacts
CONTACTKlaus Fassbender, Professor
CONTACTSilke Walter
PRINCIPAL_INVESTIGATORKlaus Fassbender, Professor
Universität des Saarlandes
Outcome results
None listed