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BMC Health Services Research
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Study protocol

A randomised clinical trial on a comprehensive geriatric assessment and intensive home follow-up after hospital discharge: the Transitional Care Bridge

Authors: Bianca M Buurman, Juliette L Parlevliet, Bob AJ van Deelen, Rob J de Haan, Sophia E de Rooij

Published in: BMC Health Services Research | Issue 1/2010

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Abstract

Background

Older patients are at high risk for poor outcomes after acute hospital admission. The mortality rate in these patients is approximately 20%, whereas 30% of the survivors decline in their level of activities of daily living (ADL) functioning three months after hospital discharge. Most diseases and geriatric conditions that contribute to poor outcomes could be subject to pro-active intervention; not only during hospitalization, but also after discharge. This paper presents the design of a randomised controlled clinical trial concerning the effect of a pro-active, multi-component, nurse-led transitional care program following patients for six months after hospital admission.

Methods/Design

Three hospitals in the Netherlands will participate in the multi-centre, double-blind, randomised clinical trial comparing a pro-active multi-component nurse-led transitional care program to usual care after discharge. All patients acutely admitted to the Department of Internal Medicine who are 65 years and older, hospitalised for at least 48 hours and are at risk for functional decline are invited to participate in the study. All patients will receive integrated geriatric care by a geriatric consultation team during hospital admission. Randomization, which will be stratified by study site and cognitive impairment, will be conducted during admission. The intervention group will receive the transitional care bridge program, consisting of a handover moment with a community care Care Nurse (CN) during hospital admission and five home visits after discharge. The control group will receive 'care as usual' after discharge. The main outcome is the level of ADL functioning six months after discharge compared to premorbid functioning measured with the Katz ADL index. Secondary outcomes include; survival, cognitive functioning, quality of life, and health care utilization, satisfaction of the patient and primary care giver with the transitional care bridge program. All outcomes will be measured at three, six and twelve months after discharge. Approximately 674 patients will be enrolled to either the intervention or control group.

Discussion

The study will provide new knowledge on a combined intervention of integrated care during hospital admission, a proactive handover moment before discharge and intensive home visits after discharge.

Trial registration

Trial registration number: NTR 2384
Appendix
Available only for authorised users
Literature
1.
2.
Inouye SK, Zhang Y, Han L, Leo-Summers L, Jones R, Marcantonio E: Recoverable cognitive dysfunction at hospital admission in older persons during acute illness. J Gen Intern Med. 2006, 21: 1276-1281. 10.1111/j.1525-1497.2006.00613.x.CrossRefPubMedPubMedCentral
3.
Norman K, Pichard C, Lochs H, Pirlich M: Prognostic impact of disease-related malnutrition. Clin Nutr. 2008, 27: 5-15. 10.1016/j.clnu.2007.10.007.CrossRefPubMed
4.
Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988, 319: 1701-1707. 10.1056/NEJM198812293192604.CrossRefPubMed
5.
Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al: The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004, 170: 1678-1686.CrossRefPubMedPubMedCentral
6.
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW: The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003, 138: 161-167.CrossRefPubMed
7.
Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD: Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004, 52: 625-634. 10.1111/j.1532-5415.2004.52174.x.CrossRefPubMed
8.
Hoogerduijn JG, Schuurmans MJ, Duijnstee MS, de Rooij SE, Grypdonck MF: A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs. 2007, 16: 46-57. 10.1111/j.1365-2702.2006.01579.x.CrossRefPubMed
9.
McCusker J, Kakuma R, Abrahamowicz M: Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci. 2002, 57: M569-M577.CrossRefPubMed
10.
Covinsky KE, Palmer RM, Counsell SR, Pine ZM, Walter LC, Chren MM: Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. J Am Geriatr Soc. 2000, 48: 164-169.CrossRefPubMed
11.
Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, et al: Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008, 56: 2171-2179. 10.1111/j.1532-5415.2008.02023.x.CrossRefPubMedPubMedCentral
12.
Van CK, Braes T, Wellens N, Denhaerynck K, Flamaing J, Moons P, et al: The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc. 2010, 58: 83-92. 10.1111/j.1532-5415.2009.02621.x.CrossRef
13.
Ellis G, Langhorne P: Comprehensive geriatric assessment for older hospital patients. Br Med Bull. 2004, 71: 45-59. 10.1093/bmb/ldh033.CrossRefPubMed
14.
Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al: A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009, 150: 178-187.CrossRefPubMedPubMedCentral
15.
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, et al: Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999, 281: 613-620. 10.1001/jama.281.7.613.CrossRefPubMed
16.
Coleman EA, Parry C, Chalmers S, Min SJ: The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006, 166: 1822-1828. 10.1001/archinte.166.17.1822.CrossRefPubMed
17.
Boter H, van Delden JJ, de Haan RJ, Rinkel GJ: Modified informed consent procedure: consent to postponed information. BMJ. 2003, 327: 284-285. 10.1136/bmj.327.7409.284.CrossRefPubMedPubMedCentral
18.
Coleman EA, Smith JD, Frank JC, Min SJ, Parry C, Kramer AM: Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention. J Am Geriatr Soc. 2004, 52: 1817-1825. 10.1111/j.1532-5415.2004.52504.x.CrossRefPubMed
19.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963, 185: 914-919.CrossRefPubMed
20.
Holman R, Weisscher N, Glas CA, Dijkgraaf MG, Vermeulen M, de Haan RJ, et al: The Academic Medical Center Linear Disability Score (ALDS) item bank: item response theory analysis in a mixed patient population 1. Health Qual Life Outcomes. 2005, 3: 83-10.1186/1477-7525-3-83.CrossRefPubMedPubMedCentral
21.
Jorm AF: A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med. 1994, 24: 145-153. 10.1017/S003329170002691X.CrossRefPubMed
22.
EuroQol--a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990, 16: 199-208. 10.1016/0168-8510(90)90421-9.
23.
Meiland FJ, Droes RM, de LJ, Vernooij-Dassen MJ: Facilitators and barriers in the implementation of the meeting centres model for people with dementia and their carers. Health Policy. 2005, 71: 243-253. 10.1016/j.healthpol.2004.08.011.CrossRefPubMed
24.
AbuRuz SM, Bulatova NR, Yousef AM: Validation of a comprehensive classification tool for treatment-related problems. Pharm World Sci. 2006, 28: 222-232. 10.1007/s11096-006-9048-0.CrossRefPubMed
25.
Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA: Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr. 2005, 24: 75-82. 10.1016/j.clnu.2004.07.015.CrossRefPubMed
26.
Collins SL, Moore RA, McQuay HJ: The visual analogue pain intensity scale: what is moderate pain in millimetres?. Pain. 1997, 72: 95-97. 10.1016/S0304-3959(97)00005-5.CrossRefPubMed
27.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI: Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990, 113: 941-948.CrossRefPubMed
28.
Arroll B, Khin N, Kerse N: Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ. 2003, 327: 1144-1146. 10.1136/bmj.327.7424.1144.CrossRefPubMedPubMedCentral
29.
Sheikh JI, Yesavage JA: Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist: The Journal of Aging and Mental Health. 1986, 5: 165-173.CrossRef
30.
Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed
31.
Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969, 9: 179-186.CrossRefPubMed
32.
de Jong GJ, van TT: [A shortened scale for overall, emotional and social loneliness]. Tijdschr Gerontol Geriatr. 2008, 39: 4-15. 10.1007/BF03078118.CrossRef
Metadata
Title
A randomised clinical trial on a comprehensive geriatric assessment and intensive home follow-up after hospital discharge: the Transitional Care Bridge
Authors
Bianca M Buurman
Juliette L Parlevliet
Bob AJ van Deelen
Rob J de Haan
Sophia E de Rooij
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-296

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