Home Care Clinical Trial
Official title:
"COMPARATIVE STUDY OF TWO MODELS OF PREVENTIVE HOME VISITS "
Home care is the assistance provided at home to those who can not travel to their Health
Center. There are multiple studies on models of home care and many discrepancies about the
impact that preventive home visits can have. Hypothesis: home care is expected to be better
if performed by a team dedicated exclusively to the home patient, than to the traditional
model, where the patient is assisted by the team that cares for the rest of the community.
Goals:
Main: determine the difference in median cumulative days of hospital admission in 12 months.
Secondaries:
- results in health
- in health experience in efficiency Methodology: Quasi-experimental study of two years
duration. All the subjects included in the Home Care Program and that meet the inclusion
and exclusion criteria are studied. The care team will provide the informed consent and
information sheet to the patient and clinical scales at the beginning and end of the
study. Researchers will be responsible for the collection of data that they will
anonymize and guard. Statistical analysis: The analyzes will be calculated with the
statistical package SPSS version 21 Expected results: hospital admissions (25%) and
cumulative days by admission and patient by 65% are expected to improve in the model
under study. Applicability and relevance: the trend towards a greater aging of the
population makes it necessary to study models of care that allow us to detect which can
be beneficial to the population and feasible in our current context.
Our purpose will be to compare 2 models of home care corresponding to 2
Primary Care Centers (EAP):
- Model integrated (EAP Gran Sol), traditional, continuity, made by the UBA with care of
the home patient by the usual care team (family physician and nurse)
- Model functional (EAP Apenins), based on the internal reorganization of the EAP:
equipment specific home care program composed of family physician and nurse, with
dedication exclusively to Preventive home visits, with training aimed at excellence in
the Management of fragile patients with pluripathology and palliative care.
HYPOTHESIS. A care group dedicated exclusively to the ATDOM patient with what it entails in
dedication of time and specific knowledge could get better results in health, optimize health
resources and at the same time achieve greater satisfaction and quality of life to these
patients. That is why our hypothesis will be that it is expected that the patient's global
assistance attended from Primary Care in your home is better if it is performed by a Primary
Care team trained for it with exclusive dedication to this type of patient, that, with the
traditional model, where the patient that is attended at home is assisted by the clinical
team that serves the rest of the community.
OBJECTIVES Main objective The main objective will be the comparison of the two models of home
care in Primary care previously described by the difference in the average number of days
hospitalized for 12 months among the people served in an integrated model of home care and
among those served in a functional model. 3.2 Secondary objectives We will analyze them under
a triple vision AIM, triple goal, better health, better care, lower costs, -effectiveness,
efficiency and experience in people's health-
- Results in health: comparison in mortality at 12 months and integral geriatric
assessment.
- Results in experience in health care and quality of life:
Comparison of both models in terms of self-perception in patients' health included in the
preventive home care program, the patient's experience in attention to their health and
overload of the caregiver.
-Results in efficiency and resource utilization: comparison in professional assistance,
consumption of intermediate resources, consumption of social products, quality in the
prescription.
METHODOLOGY OF THE STUDY.
- Design of the study. It is a quasi-experimental study of 2 population samples. The group
of study is composed of the sample of subjects treated with the home care model
exclusive and expert. The control group is made up of the subjects that are treated with
the model of traditional home care. The study is expected to have a duration of 2 years
that will be the time of follow-up of each participant, being able present the
possibility of doing later substudies.
- Population under study. Justification of the choice of the comparator. The integrated
model of home care that is implemented in EAP Gran Sol is compared with the proposed new
functional model that includes a team of family doctor and nurse dedicated exclusively
to patient care included in the home care program and who have received specific
training. This intervention has been carried out in EAP Apenins since 2013.
To the subjects of this obtained sample, a telephone call will be made inviting them to
participate in the study, agreeing a visit by the doctor or nurse responsible for the patient
and the subject of the project will be informed. In the agreed view, will give the informed
consent and the information sheet to the patient. Once signed in informed consent by the
subject or in case of patients with deterioration cognitive, by the caregiver, the
self-administered scales EuroQOL and IEXPACto the patient, in the case of patients with
cognitive impairment, at caregiver and the Zarit questionnaire to the main caregiver so that
complete They will be given an envelope to enter the completed scales that will be delivered
closed to the healthcare professional. Fragility will be measured with instrument of
Gérontopole at that time. These scales will be redelivered the patient and the caregiver at
the end of the study, after 2 years, with the same methodology.
It is considered inevitable that professionals know how to measure themselves since they have
their collaboration for the delivery of informed consent and information sheet to patient and
the EuroQol, IEXPAC and Zarit scales and calculation of fragility index.
There will be 2 training sessions for healthcare professionals on the project of the study
and the use of the scales they will deliver. Losses of selection of the sample are considered
to the subjects or main caregivers, in the case of subjects with cognitive impairment, who do
not sign informed consent.
Every 6 months the researchers will contact the subjects by telephone participants of the
study (each of their Primary Care Center) and on that call will proceed to question about
possible admission to private hospitals, stay in day centers or answer questions or provide
information about the study. Study groups.
They are the following:
A control group of patients included in the Home Care program of the ABS Gran Sol where11
healthcare teams work with 241 patients in total in the Home care program (date December
2016) And a study group, of patients included in the Home Care program of ABS Apenins, the
which have a healthcare team that works exclusively for home care with 113 patients (date
December 2016) Study sample. Patients will be included who are in the Home care program and
who comply with the Inclusion and exclusion criteria.
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