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Trial record 1 of 4 for:    integrated care AND Geneva
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Efficacy of Integrated Care to Reduce Hospitalization and Nursing Home Placement in Community Dwelling Frail Elderly

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ClinicalTrials.gov Identifier: NCT02084108
Recruitment Status : Completed
First Posted : March 11, 2014
Last Update Posted : March 11, 2014
Sponsor:
Information provided by (Responsible Party):
Laura Di Pollina, University Hospital, Geneva

Brief Summary:

Introduction: Care of frail and dependent elders with multiple chronic conditions is a major challenge for health care systems. The objective of this study is to evaluate the effect of coordinating the existing structures in the private and public sector for the care of frail and dependent persons over age 60, and susceptible of presenting complex bio-psycho-social issues. This approach is aimed at improving the coordination, continuity, quality and efficacy of care in this population, which presents a high risk of hospitalization, emergency room visits, institutionalization and mortality.

Methods: Three-year cluster randomised controlled trial. A control group receiving usual care (follow up by primary care physician and home nursing service) will be compared to an intervention group that will be provided, in addition, in-home multidimensional geriatric assessment with access to a 24h/7 day a week call service, and coordinated long-term follow-up. Survival analyses will be conducted to compare the outcomes between groups.

Primary outcome:

- Hospitalizations: rates of first hospitalization, number, cause and length of stay.

Secondary outcomes:

  • Emergency room visits: rates of first visit, number and cause
  • Institutionalization: number of patients
  • Mortality: rate and number of deaths and place of death (home versus hospital)

Condition or disease Intervention/treatment Phase
Chronic Diseases Other: intervention Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 301 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Efficacy of Integrated Care to Decrease Hospitalization and Institutionalization in Community Dwelling Frail Elderly, With Care Coordination Between Physicians, Home Nursing Services and a Community Geriatrics Unit.
Study Start Date : July 2009
Actual Primary Completion Date : December 2012
Actual Study Completion Date : December 2012

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
No Intervention: Control arm= usual care
Two clusters of patients over 60 years of age followed by a primary care physician and routinely evaluated by the home nursing service with the resident assessment instrument-home care (RAI-HC) and identified as frail by pre-defined clinical criteria.
Intervention arm
The intervention arm will consist of two clusters of patients over 60 years of age followed by a primary care physician and routinely evaluated by the home nursing service with the RAI-HC and identified as frail by predefined clinical criteria that will receive in addition an in-home multidimensional geriatric assessment, access 24 hours a day, 7 days a week to a call service provided by the Community Geriatrics Unit and coordinated long-term follow-up.
Other: intervention
intervention group that will be provided, in addition, in-home multidimensional geriatric assessment with access to a 24h/7 day a week call service, and coordinated long-term follow-up.




Primary Outcome Measures :
  1. Hospitalizations: rates of first hospitalization, number and reason [ Time Frame: Three years ]

Secondary Outcome Measures :
  1. Emergency room visits: rates of first visit, number and cause. [ Time Frame: Three years ]
  2. Institutionalization: number of patients [ Time Frame: Three years ]
  3. Mortality: rate and number of deaths and place of death (home versus hospital) [ Time Frame: Three years ]


Information from the National Library of Medicine

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Ages Eligible for Study:   60 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients followed by the home nursing service and primary care physician
  • Over 60 years of age
  • Able to give consent (patient or caregiver)
  • Able to speak French
  • Meeting frailty criteria as determined by one of the following alarms detected by the RAI-HC:
  • Alarm 8: cognition
  • Alarm 12: social role and function
  • Alarm 15: falls
  • Alarm 22: frailty of the informal care giver system.

Exclusion Criteria:

  • Age under 60 years
  • Unable (patient or caregiver) to give informed consent
  • Unable to communicate adequately in French
  • Patients' not receiving nursing visits (only receiving practical aid or services from occupational therapists).

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): NCT02084108


Locations
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Switzerland
University hospital of Geneva
Geneva, Switzerland, 1211
Sponsors and Collaborators
University Hospital, Geneva
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Laura Di Pollina, Doctor in medecin, University Hospital, Geneva
ClinicalTrials.gov Identifier: NCT02084108    
Other Study ID Numbers: 08-128 and 08-06
First Posted: March 11, 2014    Key Record Dates
Last Update Posted: March 11, 2014
Last Verified: March 2014
Keywords provided by Laura Di Pollina, University Hospital, Geneva:
Frail and dependent older adults
Integrated care
Home care
Multidimensional geriatric assessment
RAI-HC (resident assessment instrument- Home care)
Palliative care.
Additional relevant MeSH terms:
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Chronic Disease
Disease Attributes
Pathologic Processes