An interventional study of Transitional care model in Transitional Care, Multimorbidity and Geriatric Care, sponsored by Thekla Brunkert. Recruiting at 1 site in Switzerland. Open to participants aged 65 Years and older. Per ClinicalTrials.gov, last updated 2024-02-02.
Sponsored by Thekla Brunkert · Not applicable, Interventional, and Health services research
This clinical trial at the University Department of Geriatric Medicine FELIX Platter in Basel, Switzerland, is designed to evaluate a new transitional care model aimed at helping frail older adults after they get discharged from the hospital. The AdvantAGE study aims to explore the following questions:
Participants in the trial will be followed by advanced practice nurses for up to 90 days after hospital discharge. The patients and their caregivers will receive support in coordinating care, managing medications, and learning to manage the patient's health conditions on their own. Additionally, they will have the opportunity to engage in discussions about advanced care planning.
This is the only study on the registry with Thekla Brunkert as lead sponsor.
Counted across the registry records on this site, refreshed daily.
Additionally, participants must meet at least one of the following criteria:
Exclusion Criteria:
The intervention includes five core elements provided by a multiprofessional team: (1) continuous support for patients and caregivers; (2) care coordination with primary care providers;(3) visits at patients' homes; (4) medication- and self-management with patients and caregivers; and (5) proactive advanced care planning. Patients will receive specialized support including home visits up to 90 days after hospital discharge.
Other: Transitional care model
A newly developed care model to support frail older adults during their transition from hospital to home.
Also known as: AdvantAGE
90-days rehospitalization rate
Number of unplanned hospital admissions of any kind happening within 90 days after discharge
Time frame: 90 days post-discharge
30-days rehospitalization rate
Number of unplanned hospital admission of any kind happening within 30 days after discharge
Time frame: 30 days post-discharge
Time to readmission
Number of days between hospital discharge and unplanned hospital admission
Time frame: Up to 90 days post-discharge
Number of emergency room visits
Number of emergency room visits (with or without hospital admission) within 90 days after discharge
Time frame: 90 days post-discharge
Time to emergency room visit
Number of days between hospital discharge and emergency room visit
Time frame: Up to 90 days post-discharge
Patient's health-related quality of life
The EuroQoL-5D-5L is used to assess the health-related quality of life in patients at three time points. Prior to hospital discharge, 7 days and 90 days after hospital discharge or if the patient completed the intervention
Time frame: Up to 90 days post-discharge
Patient satisfaction questionnaire
Satisfaction regarding intervention participation
Time frame: up to 90 days post-discharge
Plan to share: No
Eligibility is decided by the study team. Share this record with your doctor or contact the team directly.
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