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Impact of a Health Intervention on Some Indicators in the Care of Chronic Complex Patient (CCP). (CCP)

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ClinicalTrials.gov Identifier: NCT03091036
Recruitment Status : Completed
First Posted : March 27, 2017
Last Update Posted : April 10, 2017
Sponsor:
Collaborator:
Hospital Universitario 12 de Octubre
Information provided by (Responsible Party):
María José del Olmo Rubio, Hospital Universitario 12 de Octubre

Brief Summary:
The aim of this study is to assess the effectiveness of proactive and integrated healthcare program for chronic complex patients (CCP). This program are based in coordination the primary level of attention with and speciality level. The objective is reducing hospital readmissions and know the benefit in total cost of care in 4 month before and 4 after intervention.

Condition or disease Intervention/treatment Phase
Preventive Care Other: Proactive healthcare intervention Not Applicable

Detailed Description:

Quasi-experimental study with single-arm (pre-post study design without control group). The investigators checking pre and post intervention the effectiveness of a healthcare program for CCP. The interventions consist:

  1. - Help the nurse in the hospital to carry out the care plans and the continuity care report.
  2. - Refer patients to the social workers.
  3. - Collaborate with the social worker to refer to centers of media, long stay and reference hospital.
  4. - Ensure the follow-up appointments for the CCP.
  5. - Make proactive calls to the CCP and/or their caregiver after discharge
  6. - Plan the hospital discharge 48 hours in advance, so that the family and the patient can be organized.

The investigator analysed if with this program, the CCP reducing hospital readmission and reducing the Hospital expenditure.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 28 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Impact of a Proactive and Integrated Health Intervention Between Different Assistance Levels Over Some Indicators in the Care of Chronic Complex Patient (CCP)
Study Start Date : July 2015
Actual Primary Completion Date : July 2016
Actual Study Completion Date : January 2017

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Proactive healthcare intervention
Participants who were included before (single-arm pre-post study), now a proactive and integrated intervention program for the health is performed of the complex chronic patient, based in an improvement of the care process.
Other: Proactive healthcare intervention
There is an intervention in the coordination of health resources, and monitoring readmissions and know the benefit in total cost of care in 4 month.




Primary Outcome Measures :
  1. Pre-post change in days of Hospital stay from baseline to 16 weeks. [ Time Frame: Baseline and 16 weeks. ]
    The same group of patients are analyzed the days of hospital stay at the end of 16 weeks of follow-up pre intervention (baseline) and 16 week after the intervention.


Secondary Outcome Measures :
  1. Number of hospital readmissions visits for CCP change from baseline to 16 weeks. [ Time Frame: Baseline and 16 weeks. ]
    The same group of patients are analyzed the number of hospital readmissions visit for CCP at the end of 16 weeks pre intervention (considered baseline) of follow-up and 16 weeks after the intervention.

  2. Number of urgency visits for CCP change from baseline to 16 weeks. [ Time Frame: Baseline and 16 weeks. ]
    The same group of patients are analyzed the number of urgency visits and primary care visit for CCP at the end of 16 weeks pre intervention (considered baseline) of follow-up and 16 weeks after the intervention.

  3. Number of primary care visits for CCP change from baseline to 16 weeks. [ Time Frame: Baseline and 16 weeks. ]
    The same group of patients are analyzed the number of primary care visits for CCP at the end of 16 weeks pre intervention (considered baseline) of follow-up and 16 weeks after the intervention.



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Ages Eligible for Study:   75 Years and older   (Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patient ≥ 75 years.
  • Having attended 5 or more emergency visits or having had more than 3 hospital admissions in the last 12 months.
  • Identified with social risk alert.

Exclusion Criteria:

  • Participate in other health programs (AHT, diabetes mellitus,...).
  • Terminal patient.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03091036


Locations
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Spain
Hospital Universitario 12 de Octubre de Madrid
Madrid, Spain, 28041
Sponsors and Collaborators
María José del Olmo Rubio
Hospital Universitario 12 de Octubre
Investigators
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Principal Investigator: María José del Olmo Rubio Hospital 12 de Octubre de Madrid

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Responsible Party: María José del Olmo Rubio, Principal investigator, Hospital Universitario 12 de Octubre
ClinicalTrials.gov Identifier: NCT03091036     History of Changes
Other Study ID Numbers: InveCuidPCC16
First Posted: March 27, 2017    Key Record Dates
Last Update Posted: April 10, 2017
Last Verified: April 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by María José del Olmo Rubio, Hospital Universitario 12 de Octubre:
Chronic
Complex