Rehospitalization Clinical Trial
Official title:
Domiciliary Intervention by Occupational Therapy After Hospital Discharge, to Prevent Rehospitalization in Elderly: Randomized Clinical Trial
The purpose of this study is to determine whether a home visit by an Occupational Therapist is effective in reducing the rehospitalization rates in elderly patients after hospital discharge.
Introduction: The hospitalization of the elderly is a frequent event that is associated with
complications including loss of functionality, which makes it difficult for the person to
reinstate to their original context after discharge, increasing the likelihood of
rehospitalization.
Objective : To describe and compare the impact of home-based intervention by Occupational
Therapists (OT) in the likelihood of rehospitalization at 6 months versus usual care in
persons older than 60 years after discharge.
Design : Randomized controlled trial in medical units of the Hospital Clínico de la
Universidad de Chile (HCUCh) and Hospital de la Fuerza Aérea de Chile (HFACH)
Patients: Two hundred and six patients aged 60 years or older admitted for acute or
decompensated chronic disease to either HCUCH or HFACH, with a life expectancy greater than
6 months, not institutionalized prior to hospitalization or discharge destination , and
provided that they have a person of reference after hospital discharge .
Methods: The control group consists of the usual care regarding post discharge patients, in
comparison to the experimental group, which , besides the usual discharge plan, considers a
home visit from OT on 2 occasions for 6 months, who will apply the following plan of action:
Compliance assessment of pharmacological and non-pharmacological indications, applying a
checklist of home safety evaluation and structuring of an occupational routine, education of
stimulation strategies, education in recognition of warning signs and proper use of health
services. Patients will be recruited between 24 and 48 hours prior to hospital discharge
where they will be invited to participate. Informed consent will be retrieved, and
demographic information of patients and pre- hospitalization functional backgrounds will be
collected during this period, and at discharge by means of Barthel Index (independence /
dependence in basic activities of daily living (ADL)), Lawton & Brody Scale (ADL
instrumental), Questionnaire Pfeffer Functional Activities ( FAQ), Confusion Assessment
Method (CAM) (delirium at discharge), Pfeiffer Questionnaire (Short Portable Mental Status
Questionnaire: SPMSQ ) (cognition), and Geriatrics Cumulative Illness Rating Scale disease (
CIRS -G) (comorbidity). Both groups will receive telephone follow-up at 4, 12 and 24 weeks
after hospital discharge with intent to evaluate functionality and rehospitalization.
Allocators, medical team giving hospital discharge, pone interviewers, and data analysts
will be blind of the intervention allocation.
Expected Results: the home-based intervention after discharge with OT reduce the rate of
rehospitalization in at least 40 % at 6 months in people over 60 years compared with usual
care .
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Investigator, Outcomes Assessor), Primary Purpose: Treatment
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