An interventional study of CWS in Hospital in Functional Decline and Complications of Frail Older Patients Admitted to Hospital, sponsored by Radboud University Medical Center. Completed at 1 site in Netherlands. Open to participants aged 70 Years and older. Per ClinicalTrials.gov, last updated 2013-01-23.
Sponsored by Radboud University Medical Center · Not applicable, Interventional, and Supportive care
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.
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:
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:
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 Medical Center is the lead sponsor of 959 studies on the registry; 134 are open to participants now.
Of its 6 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.
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Exclusion Criteria:
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: * will have a comprehensive (geriatric) assessment using an adapted version of the EasyCare instrument; * a geriatric consultation team will propose/recommend a tailored care and welfare plan, which will be updated at the moment of discharge; * will be discussed at least once in a multidisciplinary meeting; * a structured medication review will be carried out by a geriatrician; * is offered an activation programme by volunteers focusing on improvement of orientation, mobility, social activities or nutrition; * may receive a consult of a geriatrician, if judged necessary; * will receive extra attention on discharge arrangements. Hospital staff will be educated, disease-specific guidelines will be adapted to frail older patients.
Patient safety
cumulative incidence in delirium, falls, functional decline (GARS), and loss of cognition (MMSE)
Time frame: during hospital stay
Maintenance or improvement of functional status (patient safety)
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
Time frame: 2 weeks before admission, discharge, 3 months after discharge
Incidence delirium (patient safety)
incidence delirium (as judged by an independent physician, structured by daily application of the Confusion Assessment Method (CAM) and Delirium Observation Scale (DOS))
Time frame: during hospital stay
Autonomy of patient (quality of care)
Consumer Quality Indicator CWS In Hospital: to address autonomy of patients, developed by own researchers
Time frame: before implementation and one year after implementation of CWS InHospital
OPROCS (quality of care)
OPROCS = cumulative outcome measure functional ability and quality of life etc. as determined by the elderly (Minimum Data Set)
Time frame: discharge and 3 months follow-up
Validity of delirium diagnoses by the medical specialty involved (quality of care)
recognition of delirium by medical staff (nurses and doctors) compared to diagnoses by independent physician using CAM and DRS-r-98
Time frame: before and one year after implementation CWS InHospital
Readmissions (quality of care)
readmissions within 1 month after discharge (Minimum Data Set, electronic health record)
Time frame: within 1 month after discharge
Objective burden of care among informal caregivers (quality of care)
objective burden of care among informal caregivers (Minimum Data Set)
Time frame: from admission to 3 months after discharge patient
Cost-effectiveness
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
Time frame: from admission to 3 months after discharge
This study is completed, as verified in Jan 2013. You cannot join it, but the record below documents what was studied.
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Radboud University Medical Center