Impact of a Transitional Care Program on 30-Day Hospital Readmissions for Elderly Patients Discharged From a Short Stay Geriatric Ward

Geriatrics Clinical Trial

— PROUST  

Official title:

Impact of a Transitional Care Program Involving an Advanced Practice Nurse on 30-Day Hospital Readmissions for Elderly Patients Discharged From a Short Stay Geriatric Ward (PROUST Study)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02421133
• Other study ID #: 2014.874
• Status: Completed
• Phase: N/A
• Start date: July 2015
• Est. completion date: November 30, 2016

Study information

• Verified date: March 2022
• Source: Hospices Civils de Lyon
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

In France, it has be estimated that the hospital readmission rate within 30 days of patients aged 75 or older is 14% (IC95% [12.0-16.7]), nearly a quarter being avoidable. There is evidence that interventions "bridging" the transition from hospital to home involving a dedicated professional (usually nurses) would be most effective in reducing the risk of readmission, but the level of evidence of current studies is low. Our study aims to assess the impact of a program of transitional care from hospital to home for people of 75 years old or more admitted to acute care.

Description:

The study is a stepped wedge randomized cluster study. Intervention: The transition care program, involving a dedicated advanced practice nurse, will include: 1) during the patient's stay in hospital: an individualized needs-based comprehensive discharge plan and a transitional care record ; the notification of the primary care physician about inpatient care and hospital discharge; 2) the day of the discharge: specific explanations about the organization of home care provided by the transition care nurse to the patient; 3) during 4 weeks after discharge: monitoring patients and caregivers regularly through home visits and/or telephone contact,

Recruitment information / eligibility

• Status: Completed
• Enrollment: 630
• Est. completion date: November 30, 2016
• Est. primary completion date: November 30, 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 75 Years and older

Eligibility

Inclusion Criteria:

• Patient hospitalized for 48 hours or more in one of the acute geriatric service participating to the study.

• Aged 75 or older.

• Leaving at home and with home as the planned discharge after the admission.

• At risk of hospital readmission emergency visit rates after discharge (if he has two or more of the following criteria (taken from the Triage Risk Screening Tool and from the 2013 French recommendation)).

Exclusion Criteria:

• Patient leaving in a retirement home.

• Patient hospitalized at home.

• Patient leaving at home but at 30 km (18 miles) or more from the service of his index admission

Related Conditions & MeSH terms

• Geriatrics

Intervention

Other:
• Transitional care program.
During the patient's stay in hospital, the transition nurse creates a transitional care file including information about the patient (inpatient medical and nurse care plan, medications), the discharge plan, and the contact information of the relevant primary care providers. She notifies the patient's primary care physician of the date of the discharge to home, of the potential medical problems and of the discharge care plan; a primary care physician visit is planned the month following the discharge. The day of the hospital discharge: meeting with the patient to review the follow-up recommendations. The transition nurse verifies that the medications are prescribed accordingly with the discharge plan, that the patient and his caregiver understand the prescription and are informed with the planned appointments and the biological monitoring. During 4 weeks after the hospital discharge: follow-up by the transition nurse once a week, alternately by telephone and home visit.
• standard care program
The patients will be discharged according to the usual care plan of each participating hospital. The medical team does a medical and geriatric assessment of the patients according to the recommendations. The communication of information to the primary care providers (nurse, primary care physician…) is left to the discretion of the medical teams of the discharging hospitals, according to their habits of work.

Locations

Country	Name	City	State
France	CH Gériatrique des Monts d'Or	Albigny sur Saône
France	CH Bourg-en-Bresse	Bourg en Bresse
France	Centre Hospitalier Alpes Léman	Contamine sur Arve
France	Hôpital Édouard Herriot	Lyon
France	Centre Hospitalier Lyon Sud	Pierre Benite
France	CHG Annecy	Pringy
France	CH Saint-Chamond	Saint Chamond
France	Clinique des portes du sud	Venissieux
France	CH Villefranche	Villefranche

Sponsors (1)

Lead Sponsor	Collaborator
Hospices Civils de Lyon

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	30-Day unscheduled hospital readmission or emergency visit rate after the index hospital discharge.	Unscheduled hospital readmissions are hospitalizations that are not planned at the moment of the discharge (for example: hospitalization after an emergency visit or upon request of the primary care physician).	Within 30 days after hospital discharge.
Secondary	Length of stay in the short stay geriatric ward (index hospitalization)		Patients will be followed for the duration of hospital stay, an expected average between 2 days and 30 days
Secondary	Unscheduled hospital readmissions or emergency room visits		Within 30 and 90 days after the index hospital discharge.
Secondary	Free-hospitalization survival		Within 30 and 90 days after the index hospital discharge.
Secondary	Mortality rate		Within 30 and 90 days after the index hospital discharge.
Secondary	Adverse events (i.e. falls)		Within 30 days after the index hospital discharge.
Secondary	Quality of life.	Measured with the French version of the EUROQOL-5D.	Within 30 days after the index hospital discharge.
Secondary	Patients' satisfaction care transition programme	Measured with the Care Transition Measure® questionnaire.	Within 30 days after the index hospital discharge.
Secondary	Delay between the index hospital discharge and the implementation of home care.		Within 30 days after the index hospital discharge.
Secondary	Number of contacts between the transition nurse and the primary care providers or the hospital providers after discharge		Within 30 days after the index hospital discharge.
Secondary	Costs of unscheduled hospital readmission or emergency visit	Hospital and community care costs after discharge	30 days after discharge