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BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial

Authors: Tove Røsstad, Øyvind Salvesen, Aslak Steinsbekk, Anders Grimsmo, Olav Sletvold, Helge Garåsen

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

Improved discharge arrangements and targeted post-discharge follow-up can reduce the risk of adverse events after hospital discharge for elderly patients. Although more care is to shift from specialist to primary care, there are few studies on post-discharge interventions run by primary care. A generic care pathway, Patient Trajectory for Home-dwelling elders (PaTH) including discharge arrangements and follow-up by primary care, was developed and introduced in Central Norway Region in 2009, applying checklists at defined stages in the patient trajectory. In a previous paper, we found that PaTH had potential of improving follow-up in primary care. The aim of this study was to establish the effect of PaTH—compared to usual care—for elderly in need of home care services after discharge from hospital.

Methods

We did an unblinded, cluster randomised controlled trial with 12 home care clusters. Outcomes were measured at the patient level during a 12-month follow-up period for the individual patient and analysed applying linear and logistic mixed models. Primary outcomes were readmissions within 30 days and functional level assessed by Nottingham extended ADL scale. Secondary outcomes were number and length of inpatient hospital care and nursing home care, days at home, consultations with the general practitioners (GPs), mortality and health related quality of life (SF-36).

Results

One-hundred and sixty-three patients were included in the PaTH group (six clusters), and 141 patients received care as usual (six clusters). We found no statistically significant differences between the groups for primary and secondary outcomes except for more consultations with the GPs in PaTH group (p = 0.04). Adherence to the intervention was insufficient as only 36% of the patients in the intervention group were assessed by at least three of the four main checklists in PaTH, but this improved over time.

Conclusions

Lack of adherence to PaTH rendered the study inconclusive regarding the elderly’s functional level, number of readmissions after hospital discharge, and health care utilisation except for more consultations with the GPs. A targeted exploration of prerequisites for implementation is recommended in the pre-trial phase of complex intervention studies.

Trial registration

Clinical Trials.gov NCT01107119, retrospectively registered 2010.04.18.
Appendix
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Metadata
Title
Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial
Authors
Tove Røsstad
Øyvind Salvesen
Aslak Steinsbekk
Anders Grimsmo
Olav Sletvold
Helge Garåsen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2206-3

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