scholarly journals Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study

2021 ◽  
Vol 9 (13) ◽  
pp. 1-166
Author(s):  
Julian Bion ◽  
Cassie Aldridge ◽  
Chris Beet ◽  
Amunpreet Boyal ◽  
Yen-Fu Chen ◽  
...  
Keyword(s):  
Health Care ◽  
Hospital Admission ◽  
Hospital Care ◽  
Care Quality ◽  
Weekend Effect ◽  
Two Phase ◽  
Case Record ◽  
Emergency Hospital Admission ◽  
Day Services ◽  
Future Work

Background NHS England’s 7-day services policy comprised 10 standards to improve access to quality health care across all days of the week. Six standards targeted hospital specialists on the assumption that their absence caused the higher mortality associated with weekend hospital admission: the ‘weekend effect’. The High-intensity Specialist-Led Acute Care (HiSLAC) collaboration investigated this using the implementation of 7-day services as a ‘natural experiment’. Objectives The objectives were to determine whether or not increasing specialist intensity at weekends improves outcomes for patients undergoing emergency hospital admission, and to explore mechanisms and cost-effectiveness. Design This was a two-phase mixed-methods observational study. Year 1 focused on developing the methodology. Years 2–5 included longitudinal research using quantitative and qualitative methods, and health economics. Methods A Bayesian systematic literature review from 2000 to 2017 quantified the weekend effect. Specialist intensity measured over 5 years used self-reported annual point prevalence surveys of all specialists in English acute hospital trusts, expressed as the weekend-to-weekday ratio of specialist hours per 10 emergency admissions. Hospital Episode Statistics from 2007 to 2018 provided trends in weekend-to-weekday mortality ratios. Mechanisms for the weekend effect were explored qualitatively through focus groups and on-site observations by qualitative researchers, and a two-epoch case record review across 20 trusts. Case-mix differences were examined in a single trust. Health economics modelling estimated costs and outcomes associated with increased specialist provision. Results Of 141 acute trusts, 115 submitted data to the survey, and 20 contributed 4000 case records for review and participated in qualitative research (involving interviews, and observations using elements of an ethnographic approach). Emergency department attendances and admissions have increased every year, outstripping the increase in specialist numbers; numbers of beds and lengths of stay have decreased. The reduction in mortality has plateaued; the proportion of patients dying after discharge from hospital has increased. Specialist hours increased between 2012/13 and 2017/18. Weekend specialist intensity is half that of weekdays, but there is no relationship with admission mortality. Patients admitted on weekends are sicker (they have more comorbid disease and more of them require palliative care); adjustment for severity of acute illness annuls the weekend effect. In-hospital care processes are slightly more efficient at weekends; care quality (errors, adverse events, global quality) is as good at weekends as on weekdays and has improved with time. Qualitative researcher assessments of hospital weekend quality concurred with case record reviewers at trust level. General practitioner referrals at weekends are one-third of those during weekdays and have declined further with time. Limitations Observational research, variable survey response rates and subjective assessments of care quality were compensated for by using a difference-in-difference analysis over time. Conclusions Hospital care is improving. The weekend effect is associated with factors in the community that precede hospital admission. Post-discharge mortality is increasing. Policy-makers should focus their efforts on improving acute and emergency care on a ‘whole-system’ 7-day approach that integrates social, community and secondary health care. Future work Future work should evaluate the role of doctors in hospital and community emergency care and investigate pathways to emergency admission and quality of care following hospital discharge. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.

scholarly journals Changes in weekend and weekday care quality of emergency medical admissions to 20 hospitals in England during implementation of the 7-day services national health policy

2020 ◽  
pp. bmjqs-2020-011165
Author(s):  
Julian Bion ◽  
Cassie Aldridge ◽  
Alan J Girling ◽  
Gavin Rudge ◽  
Jianxia Sun ◽  
...  
Keyword(s):  
Adverse Event ◽  
Quality Of Care ◽  
National Health ◽  
Hospital Care ◽  
Care Quality ◽  
Weekend Effect ◽  
Early Warning Score ◽  
Emergency Medical ◽  
Day Services

BackgroundIn 2013, the English National Health Service launched the policy of 7-day services to improve care quality and outcomes for weekend emergency admissions.AimsTo determine whether the quality of care of emergency medical admissions is worse at weekends, and whether this has changed during implementation of 7-day services.MethodsUsing data from 20 acute hospital Trusts in England, we performed randomly selected structured case record reviews of patients admitted to hospital as emergencies at weekends and on weekdays between financial years 2012–2013 and 2016–2017. Senior doctor (‘specialist’) involvement was determined from annual point prevalence surveys. The primary outcome was the rate of clinical errors. Secondary outcomes included error-related adverse event rates, global quality of care and four indicators of good practice.ResultsSeventy-nine clinical reviewers reviewed 4000 admissions, 800 in duplicate. Errors, adverse events and care quality were not significantly different between weekend and weekday admissions, but all improved significantly between epochs, particularly errors most likely influenced by doctors (clinical assessment, diagnosis, treatment, prescribing and communication): error rate OR 0.78; 95% CI 0.70 to 0.87; adverse event OR 0.48, 95% CI 0.33 to 0.69; care quality OR 0.78, 95% CI 0.70 to 0.87; all adjusted for age, sex and ethnicity. Postadmission in-hospital care processes improved between epochs and were better for weekend admissions (vital signs with National Early Warning Score and timely specialist review). Preadmission processes in the community were suboptimal at weekends and deteriorated between epochs (fewer family doctor referrals, more patients with chronic disease or palliative care designation).Conclusions and implicationsHospital care quality of emergency medical admissions is not worse at weekends and has improved during implementation of the 7-day services policy. Causal pathways for the weekend effect may extend into the prehospital setting.

scholarly journals Hearing Loss and Help-Seeking Behavior

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 797-797
Author(s):  
Nicholas Reed
Keyword(s):  
Health Care ◽  
Hearing Loss ◽  
Help Seeking ◽  
Health Care Quality ◽  
Medicare Beneficiary ◽  
Care Quality ◽  
The Past ◽  
Help Seeking Behaviour ◽  
Seeking Behavior ◽  
Future Work

Abstract Hearing Loss (HL) is common among older adults and is associated with poor health care quality outcomes include 30-day readmissions, length of stay, poorer satisfaction, and increased medical expenditures. These associations may manifest in changes in help-seeking behaviour. In the 2015 Current Medicare Beneficiary Study (MCBS) (n=10848; weighted sample=46.3 million), participants reported whether they knowingly had avoided seeking care in the past year and self-reported HL was measured as degree of trouble (none, a little, or a lot) hearing when using a hearing aid if applicable. In a model adjusted for demographic, socioeconomic, and health factors, those with a little trouble (OR= 1.612; 95% CI= 1.334-1.947; P<0.001) and a lot of trouble hearing (OR= 2.011; 95% CI= 1.443-2.801; P<0.001) had 61.2% and 101.1% higher odds of avoiding health care over the past year relative to participants with no trouble hearing. Future work should examine whether hearing care modifies this association.

scholarly journals Reducing Alert Fatigue by Sharing Low-Level Alerts With Patients and Enhancing Collaborative Decision Making Using Blockchain Technology: Scoping Review and Proposed Framework (MedAlert) (Preprint)

2020 ◽  
Author(s):  
Paul Kengfai Wan ◽  
Abylay Satybaldy ◽  
Lizhen Huang ◽  
Halvor Holtskog ◽  
Mariusz Nowostawski
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Scoping Review ◽  
Health Care Quality ◽  
Research Question ◽  
Clinical Decision ◽  
Care Quality ◽  
Alert Fatigue ◽  
Low Level ◽  
Future Work

BACKGROUND Clinical decision support (CDS) is a tool that helps clinicians in decision making by generating clinical alerts to supplement their previous knowledge and experience. However, CDS generates a high volume of irrelevant alerts, resulting in alert fatigue among clinicians. Alert fatigue is the mental state of alerts consuming too much time and mental energy, which often results in relevant alerts being overridden unjustifiably, along with clinically irrelevant ones. Consequently, clinicians become less responsive to important alerts, which opens the door to medication errors. OBJECTIVE This study aims to explore how a blockchain-based solution can reduce alert fatigue through collaborative alert sharing in the health sector, thus improving overall health care quality for both patients and clinicians. METHODS We have designed a 4-step approach to answer this research question. First, we identified five potential challenges based on the published literature through a scoping review. Second, a framework is designed to reduce alert fatigue by addressing the identified challenges with different digital components. Third, an evaluation is made by comparing MedAlert with other proposed solutions. Finally, the limitations and future work are also discussed. RESULTS Of the 341 academic papers collected, 8 were selected and analyzed. MedAlert securely distributes low-level (nonlife-threatening) clinical alerts to patients, enabling a collaborative clinical decision. Among the solutions in our framework, Hyperledger (private permissioned blockchain) and BankID (federated digital identity management) have been selected to overcome challenges such as data integrity, user identity, and privacy issues. CONCLUSIONS MedAlert can reduce alert fatigue by attracting the attention of patients and clinicians, instead of solely reducing the total number of alerts. MedAlert offers other advantages, such as ensuring a higher degree of patient privacy and faster transaction times compared with other frameworks. This framework may not be suitable for elderly patients who are not technology savvy or in-patients. Future work in validating this framework based on real health care scenarios is needed to provide the performance evaluations of MedAlert and thus gain support for the better development of this idea. CLINICALTRIAL

scholarly journals Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Angela Nikelski ◽  
Armin Keller ◽  
Fanny Schumacher-Schönert ◽  
Terese Dehl ◽  
Jessica Laufer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Collaborative Care ◽  
Hospital Care ◽  
Care Management ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Somatic Illness

Abstract BackgroundSectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmission, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to test the effectiveness of a collaborative care model for people with cognitive impairment (PCI) and current hospital treatment due to a somatic illness to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors.Methods The trial is a longitudinal multisite randomized controlled trial with two arms (“care as usual” and “intersectoral care management”). Inclusion criteria at the time of hospital admission due to a somatic illness: age 70+, cognitive impairment (Mini Mental State Examination, MMSE ≤ 26), live at home, provide written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (three and twelve months after discharge). The estimated sample size is n=398 participants together with (where available) their respective informal caregivers.In the intersectoral care management group, specialized care managers will develop, implement and monitor individualized treatment and care based on comprehensive assessments of the patients and informal caregivers for unmet needs at the hospital and in their homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden.DiscussionIn the event of proving efficacy, this trial delivers proof of concept for implementation into routine care. Cost-effectiveness analyses as well as an independent process evaluation increase the likelihood of meeting this goal. The trial allows in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. Highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, the opportunities and barriers to meeting those needs during the hospital stay and after discharge.Trial registration ClinicalTrials.gov Identifier: NCT03359408

scholarly journals Is there a relationship between hospital care quality assessemnt and the patient’s place of residence?

2015 ◽  
Vol 125 (2) ◽  
pp. 77-82
Author(s):  
Marek Kos ◽  
Agnieszka Dziewa ◽  
Bartłomiej Drop ◽  
Marzena Furtak-Niczyporuk ◽  
Ewa Warchoł-Sławińska
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Medical Care ◽  
Hospital Care ◽  
Care Facility ◽  
Care Quality ◽  
Satisfaction Survey ◽  
Place Of Residence ◽  
Patient Satisfaction Survey

Abstract Introduction. Measuring the patient satisfaction with the hospital stay, as well as the knowledge of their requirements are very important in the management of health institutions. A good example of the recognition of patients’ expectations is studying the level of satisfaction with specially prepared questionnaires. Aim. The aim of the study was to investigate the relationship between the patients’ place of residence and their satisfaction with the medical care they received when treated in local hospitals Material and methods. Patient satisfaction survey was carried out in the Independent Public Health Care Centre in Kraśnik in two subsequent years: at the turn of 2011/2012 and in February 2013. The survey consisted of patients hospitalized in the surgical wards of the hospital. A testing tool for this survey was a self-designed questionnaire entitles “Patient satisfaction survey” specifically developed by nursing managers and approved by the management of the hospital. Results. Patients of the District Hospital in Kraśnik gave their complex assessment of satisfaction with the benefits provided by the health care facility, taking into account not only the quality of strictly medical services, but the entire infrastructure of the hospital, including ancillary services. The obtained results gave a positive assessment of the analyzed branches. No statistically significant differences between the assessments of rural and urban inhabitants were found. The results allow knowledge of the strengths and weaknesses of medical care in the wards. Conclusions. Residents of rural areas, who are slightly better than those who live in cities, assess the work of local hospital surgical wards. You can clearly see it by assessing the quality of nurses’ and doctors’ work and the assessment of nutrition and the appearance of patient rooms. Systematic research, measurement and evaluation of patient satisfaction with hospital care can be the basis for the improvement and ensure an appropriate level of quality

scholarly journals Reducing Alert Fatigue by Sharing Low-Level Alerts With Patients and Enhancing Collaborative Decision Making Using Blockchain Technology: Scoping Review and Proposed Framework (MedAlert)

10.2196/22013 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e22013
Author(s):  
Paul Kengfai Wan ◽  
Abylay Satybaldy ◽  
Lizhen Huang ◽  
Halvor Holtskog ◽  
Mariusz Nowostawski
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Scoping Review ◽  
Health Care Quality ◽  
Research Question ◽  
Clinical Decision ◽  
Care Quality ◽  
Alert Fatigue ◽  
Low Level ◽  
Future Work

Background Clinical decision support (CDS) is a tool that helps clinicians in decision making by generating clinical alerts to supplement their previous knowledge and experience. However, CDS generates a high volume of irrelevant alerts, resulting in alert fatigue among clinicians. Alert fatigue is the mental state of alerts consuming too much time and mental energy, which often results in relevant alerts being overridden unjustifiably, along with clinically irrelevant ones. Consequently, clinicians become less responsive to important alerts, which opens the door to medication errors. Objective This study aims to explore how a blockchain-based solution can reduce alert fatigue through collaborative alert sharing in the health sector, thus improving overall health care quality for both patients and clinicians. Methods We have designed a 4-step approach to answer this research question. First, we identified five potential challenges based on the published literature through a scoping review. Second, a framework is designed to reduce alert fatigue by addressing the identified challenges with different digital components. Third, an evaluation is made by comparing MedAlert with other proposed solutions. Finally, the limitations and future work are also discussed. Results Of the 341 academic papers collected, 8 were selected and analyzed. MedAlert securely distributes low-level (nonlife-threatening) clinical alerts to patients, enabling a collaborative clinical decision. Among the solutions in our framework, Hyperledger (private permissioned blockchain) and BankID (federated digital identity management) have been selected to overcome challenges such as data integrity, user identity, and privacy issues. Conclusions MedAlert can reduce alert fatigue by attracting the attention of patients and clinicians, instead of solely reducing the total number of alerts. MedAlert offers other advantages, such as ensuring a higher degree of patient privacy and faster transaction times compared with other frameworks. This framework may not be suitable for elderly patients who are not technology savvy or in-patients. Future work in validating this framework based on real health care scenarios is needed to provide the performance evaluations of MedAlert and thus gain support for the better development of this idea.

scholarly journals Evaluation of maternal and neonatal hospital care: quality index of completeness

2014 ◽  
Vol 48 (4) ◽  
pp. 682-691 ◽  
Author(s):  
Ana Lúcia Andrade da Silva ◽  
Antonio da Cruz Gouveia Mendes ◽  
Gabriella Morais Duarte Miranda ◽  
Domicio Aurélio de Sá ◽  
Wayner Vieira de Souza ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Hospital Care ◽  
Care Quality ◽  
Composite Indicators ◽  
Care Practice ◽  
Delivery Care ◽  
Hospital Size ◽  
Unified Health System ◽  
Selection Of Variables

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System.METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country.RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country.CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.

scholarly journals Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Angela Nikelski ◽  
Armin Keller ◽  
Fanny Schumacher-Schönert ◽  
Terese Dehl ◽  
Jessica Laufer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Collaborative Care ◽  
Hospital Care ◽  
Care Management ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Somatic Illness

Abstract Background Sectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmission, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to test the effectiveness of a collaborative care model for people with cognitive impairment (PCI) and current hospital treatment due to a somatic illness to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. Methods The trial is a longitudinal multisite randomized controlled trial with two arms (“care as usual” and “intersectoral care management”). Inclusion criteria at the time of hospital admission due to a somatic illness: age 70+, cognitive impairment (Mini Mental State Examination, MMSE ≤ 26), live at home, provide written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (three and twelve months after discharge). The estimated sample size is n=398 participants together with (where available) their respective informal caregivers. In the intersectoral care management group, specialized care managers will develop, implement and monitor individualized treatment and care based on comprehensive assessments of the patients and informal caregivers for unmet needs at the hospital and in their homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden. Discussion In the event of proving efficacy, this trial delivers proof of concept for implementation into routine care. Cost-effectiveness analyses as well as an independent process evaluation increase the likelihood of meeting this goal. The trial allows in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. Highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, the opportunities and barriers to meeting those needs during the hospital stay and after discharge.

scholarly journals Influence of Admission Time on Health Care Quality and Utilization in Patients with Stroke: Analysis for a Possible July Effect and Weekend Effect

2021 ◽  
Vol 18 (23) ◽  
pp. 12362
Author(s):  
Chun-Yi Liu ◽  
Pei-Tseng Kung ◽  
Hui-Yun Chang ◽  
Yueh-Han Hsu ◽  
Wen-Chen Tsai
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Care Quality ◽  
Public Hospitals ◽  
Weekend Effect ◽  
Research Database ◽  
Old Patients ◽  
July Effect ◽  
Initial Hospitalization

(1) Purpose: Undesirable health care outcomes could conceivably increase as a result of the entry of new, less experienced health care personnel into patient care during the month of July (the July effect) or as a result of the less balanced allocation of health care resources on weekends (the weekend effect). Whether these two effects were present in Taiwan’s National Health Insurance (NHI) system was investigated. (2) Methods: The current study data were acquired from the NHI Research Database. The research sample comprised ≥18-year-old patients diagnosed as having a stroke for the first time from 1 January 2006 to 30 September 2012. The mortality rate within 30 days after hospitalization and readmission rate within 14 days after hospital discharge were used as health care quality indicators, whereas health care utilization indicators were the total length and cost of initial hospitalization. (3) Results: The results revealed no sample-wide July effect with regard to the four indicators among patients with stroke. However, an unexpected July effect was present among in-patients in regional and public hospitals, in which the total lengths and costs of initial hospitalization for non-July admissions were higher than those for July admissions. Furthermore, the total hospitalization length for weekend admissions was 1.06–1.07 times higher than that for non-weekend admissions; the total hospitalization length for weekend admissions was also higher than that for weekday admissions during non-July months. Thus, weekend admission did not affect the health care quality of patients with stroke but extended their total hospitalization length. (4) Conclusions: Consistent with the NHI’s general effectiveness in ensuring fair, universally accessible, and high-quality health care services in Taiwan, the health care quality of patients examined in this study did not vary significantly overall between July and non-July months. However, a longer hospitalization length was observed for weekend admissions, possibly due to limitations in personnel and resource allocations during weekends. These results highlight the health care efficiency of hospitals during weekends as an area for further improvement.

scholarly journals Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Angela Nikelski ◽  
Armin Keller ◽  
Fanny Schumacher-Schönert ◽  
Terese Dehl ◽  
Jessica Laufer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Collaborative Care ◽  
Hospital Care ◽  
Care Management ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Somatic Illness

Abstract Background Sectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmission, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to test the effectiveness of a collaborative care model for people with cognitive impairment (PCI) and current hospital treatment due to a somatic illness to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. Methods The trial is a longitudinal multisite randomized controlled trial with two arms (“care as usual” and “intersectoral care management”). Inclusion criteria at the time of hospital admission due to a somatic illness: age 70+, cognitive impairment (Mini Mental State Examination, MMSE ≤ 26), live at home, provide written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (three and twelve months after discharge). The estimated sample size is n=398 participants together with (where available) their respective informal caregivers. In the intersectoral care management group, specialized care managers will develop, implement and monitor individualized treatment and care based on comprehensive assessments of the patients and informal caregivers for unmet needs at the hospital and in their homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden. Discussion In the event of proving efficacy, this trial delivers proof of concept for implementation into routine care. Cost-effectiveness analyses as well as an independent process evaluation increase the likelihood of meeting this goal. The trial allows in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. Highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, the opportunities and barriers to meeting those needs during the hospital stay and after discharge.

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