In Hospital Care and Welfare Standard (CWSInHosp)
The current organization of hospital care for older patients with complex healthcare needs is of insufficient quality, safety and efficiency. Frail older patients have a higher risk for development of complications and consequently a higher length of hospital stay, a higher risk of functional decline, and higher care needs after discharge. As nearly half of the patients admitted to Dutch hospitals is over 65 years, it is highly necessary to adapt the organization of hospital care to their needs. Besides having introduced the medical specialty geriatrics, hospital management has not started to provide hospital wide healthcare tailored to frail older patients. Therefore, the purpose of this study is to develop and examine the effectiveness of an intervention program for frail older patients admitted to hospital aimed at preventing functional decline and other hospital related negative outcomes.
Functional Decline and Complications of Frail Older Patients Admitted to Hospital
Other: CWS in Hospital
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Supportive Care
|Official Title:||Towards an In Hospital CARE AND WELFARE STANDARD for Frail Elderly|
- Patient safety [ Time Frame: during hospital stay ] [ Designated as safety issue: No ]cumulative incidence in delirium, falls, functional decline (GARS), and loss of cognition (MMSE)
- Maintenance or improvement of functional status (patient safety) [ Time Frame: 2 weeks before admission, discharge, 3 months after discharge ] [ Designated as safety issue: No ]
maintenance or improvement of functional status (Groningen Activity Restriction Scale GARS)):
- difference between 2 weeks before admission and discharge
- difference between discharge and 3 months after discharge
- difference between 2 weeks before admission and 3 months after discharge
- Incidence delirium (patient safety) [ Time Frame: during hospital stay ] [ Designated as safety issue: No ]incidence delirium (as judged by an independent physician, structured by daily application of the Confusion Assessment Method (CAM) and Delirium Observation Scale (DOS))
- Autonomy of patient (quality of care) [ Time Frame: before implementation and one year after implementation of CWS InHospital ] [ Designated as safety issue: No ]Consumer Quality Indicator CWS In Hospital: to address autonomy of patients, developed by own researchers
- OPROCS (quality of care) [ Time Frame: discharge and 3 months follow-up ] [ Designated as safety issue: No ]OPROCS = cumulative outcome measure functional ability and quality of life etc. as determined by the elderly (Minimum Data Set)
- Validity of delirium diagnoses by the medical specialty involved (quality of care) [ Time Frame: before and one year after implementation CWS InHospital ] [ Designated as safety issue: No ]recognition of delirium by medical staff (nurses and doctors) compared to diagnoses by independent physician using CAM and DRS-r-98
- Readmissions (quality of care) [ Time Frame: within 1 month after discharge ] [ Designated as safety issue: No ]readmissions within 1 month after discharge (Minimum Data Set, electronic health record)
- Objective burden of care among informal caregivers (quality of care) [ Time Frame: from admission to 3 months after discharge patient ] [ Designated as safety issue: No ]objective burden of care among informal caregivers (Minimum Data Set)
- Cost-effectiveness [ Time Frame: from admission to 3 months after discharge ] [ Designated as safety issue: No ]expressed in incremental cost-effectiveness ratio (length of stay; use of health care services (MDS), quality of life) primary outcomes as nominator, and expressed in costs per quality adjusted life years, all related to total health care costs from a societal perspective, from admission to three months following discharge
|Study Start Date:||January 2011|
|Study Completion Date:||January 2013|
|Primary Completion Date:||July 2012 (Final data collection date for primary outcome measure)|
Experimental: CWS in Hospital
CWS in Hospital in addition to usual care
Other: CWS in Hospital
Every patient aged ≥70 years will be screened for frailty. (For) every frail patient:
Hospital staff will be educated, disease-specific guidelines will be adapted to frail older patients.
The long-term objective of this study is to examine the effectiveness and efficiency of an intervention program for frail older patients admitted to hospital. The specific aims are:
- To develop a model of integrated hospital care, according to the principle of the Chronic Care Model, focusing both on optimizing care and wellbeing. Feasibility of such a model of care was first evaluated in a pilot study.
- To conduct a before-after study to evaluate the outcomes associated with the proposed model of hospital care in frail older inpatients. Information on outcome indicators, including autonomy, quality of life, physical and cognitive functioning, and service utilization will be collected and compared before and after implementation of the proposed model of hospital care.
We expect that older patients who participate in the intervention program after one year of implementation, compared to patients who were admitted to hospital before implementation of the intervention program, will:
- have less functional decline during admission and after three months follow-up compared to two weeks before admission;
- have a lower incidence, severity and duration of delirium during admission;
- have less cognitive decline during admission;
- are more likely to be discharged directly to their own homes;
- have less weight loss between admission and discharge;
- experience less falls during admission;
- experience less readmissions within one month after discharge;
- have a shorter length of stay;
- have a significant different pattern of use of health care services after three months follow-up;
- experience more autonomy during hospital admission and better quality of life after three months follow-up.
Additionally, we expect that the knowledge and attitudes toward care for older patients among nurses and physicians will change positively during implementation of the intervention program.
|Radboud University Nijmegen Medical Centre|
|Nijmegen, Gelderland, Netherlands, 6500 HB|
|Principal Investigator:||Marcel GM Olde Rikkert, PhD||Radboud University|