Comprehensive Care Transition: A Trial of an Enhanced Care Transition Process in Dementia

Dementia Clinical Trial

Official title:

Comprehensive Care Transition: A Randomized Control Trial of an Enhanced Care Transition Process in Dementia

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02415504
• Other study ID #: REB14-45
• Status: Terminated
• Phase: N/A
• First received: December 5, 2014
• Last updated: September 20, 2016
• Start date: July 2014
• Est. completion date: May 2016

Study information

• Verified date: September 2016
• Source: Baycrest
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Ministry of Health & Long Term Care, Ontario
• Study type: Interventional

Clinical Trial Summary

This pilot study examines the impact of an enhanced care transition process vs. usual care for persons with dementia admitted to a transitional unit (hospital or LTC) for management of behavioural and psychological symptoms of dementia (BPSD) with a planned discharge to long term care (LTC) facilities or other hospital units. Deficiencies in discharge processes can contribute to poor outcomes (e.g., readmissions), and there is a dearth of research on how to improve care transitions for persons with BPSD. The investigators aim to improve the care transition process for persons with dementia and BPSD utilizing an enhanced care transition process that will contain up to 6 elements: integrated behavioural care plans, videos, patient specific briefcase containing activities to reduce BPSD, in-person care transition meeting, in-person care demonstration (when possible), and follow up visits with a transition team. The ability to determine the effect of enhanced care transitions on the clinical course of patients with planned discharge to LTC or hospital may allow for improved outcomes and an overall increased efficiency of post discharge care.

Description:

The investigators have formulated an enhanced care transition process based on factors that have been documented to support care transitions in other clinical populations (e.g., Coleman, 2003 on persons with continuous complex needs; Viggiano, et al., 2012 on persons with mental health issues), along with novel package elements based on the investigators' experience working with persons with dementia and BPSD. The investigators propose to conduct a preliminary analysis of patient and staff outcomes comparing an enhanced care transition process with a control group receiving usual care. The investigators' proposed enhanced care transition process will contain 5 elements: 1. Unified transfer care document adapted to the post-care transition location 2. Videos of BPSD management to better communicate care provision, 3. Provision to -the post-care transition location a patient specific briefcase containing activities that help to reduce BPSD, 4. In-person care transition meeting between sites, including the family, to transfer knowledge, 5. In person care demonstration (when possible), and 6. Follow-up visits post transition with a transition team (a service already in existence but not consistently used). The investigators hope that with improved communication, discharge locations will be better equipped to manage BPSD, and reduce the likelihood of adverse events for both patients and staff.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 29
• Est. completion date: May 2016
• Est. primary completion date: May 2016
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 55 Years and older

Eligibility

Inclusion Criteria:

• Patients on behavioural transitional support unit's at Baycrest (Behavioural Neurology Unit, transitional Behavioural Support Unit) who are admitted for behavioural and psychological symptoms of dementia (BPSD)

• Diagnosed with a degenerative dementia

• Over 55 years old at the time of discharge, with a planned discharge to a long-term care (LTC) facility or another hospital unit will be eligible for the study

Exclusion Criteria:

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care

Related Conditions & MeSH terms

• BPSD
• Dementia

Intervention

Behavioral:
• Enhanced care transition
Enhanced care transition discharge package: (1) an integrated behavioural care plan, (2) an in-person discharge meeting including family, post-care transition staff (LTC or another hospital unit) and unit staff, (3) videos of responsive behaviours and non-pharmacological interventions, (4) a briefcase of favoured activities, (5) an in-person care demonstration, and (6) involvement of a transitional care team.
• Standard care transition
Standard care transition discharge package: The standard care transition varies by unit, and either consists of: (1) a discipline specific care plan, (2) a phone discharge meeting between unit staff and post-care transition staff (LTC or another hospital unit) and (3) a follow-up phone call with social work OR (1) a discipline specific care plan, (2) an in-person meeting between unit staff and (family) caregivers, (3) involvement of a transitional care team, and (4) a follow-up phone call with social work.

Locations

Country	Name	City	State
Canada	Baycrest	Toronto	Ontario

Sponsors (2)

Lead Sponsor	Collaborator
Baycrest	Ontario Ministry of Health and Long Term Care

Country where clinical trial is conducted

Canada, 

References & Publications (2)

Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003 Apr;51(4):549-55. Review. — View Citation

Viggiano T, Pincus HA, Crystal S. Care transition interventions in mental health. Curr Opin Psychiatry. 2012 Nov;25(6):551-8. doi: 10.1097/YCO.0b013e328358df75. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Post-Care Transition (PCT) questionnaire	Likert scales and open-ended questions measuring change in the transitioned resident's identified behaviour(s).	Change in resident's baseline behaviour(s) at 2 and 4 weeks	No
Secondary	Social work assessment questionnaire	Likert scales and open-ended questions evaluating the transition process and the post-care transition location.	At 6 months after baseline	No
Secondary	Substitute Decision Maker (SDM) satisfaction questionnaire	Likert scales and open-ended questions measuring the SDM's satisfaction with resident's transition.	At baseline	No
Secondary	Substitute Decision Maker (SDM) satisfaction questionnaire	Likert scales and open-ended questions measuring the SDM's satisfaction with resident's transition.	Change from baseline at 2 weeks	No
Secondary	Substitute Decision Maker (SDM) questionnaire	Likert scales and open-ended questions measuring the SDM's perception of the resident's identified baseline behaviour(s).	At baseline	No
Secondary	Substitute Decision Maker (SDM) questionnaire	Likert scales and open-ended questions measuring the SDM's perception of change in the transitioned resident's identified behaviour(s).	Change in resident's baseline behaviour(s) at 2 and 4 weeks	No
Secondary	Post-Care Transition (PCT) questionnaire	Likert scales and open-ended questions measuring change in the transitioned resident's identified behaviour(s).	Change in resident's baseline behaviour(s) at 3 and 6 months	No
Secondary	Post-Care Transition (PCT) staff satisfaction questionnaire	Likert scales and open-ended questions evaluating staff satisfaction with the resident's transition process.	Change from baseline at 2 and 4 weeks	No
Secondary	Chart review	Resident's additional dependent data collection (e.g., demographics, identified behaviours, Cohen Mansfield Agitation Inventory score, etc.)	At baseline	No