Impact of a Transitional Care Program on 30-Day Hospital Readmissions for Elderly Patients Discharged From a Short Stay Geriatric Ward (PROUST)
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|ClinicalTrials.gov Identifier: NCT02421133|
Recruitment Status : Recruiting
First Posted : April 20, 2015
Last Update Posted : October 3, 2016
|Condition or disease||Intervention/treatment||Phase|
|Geriatrics||Other: Transitional care program. Other: standard care program||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||630 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Health Services Research|
|Official Title:||Impact of a Transitional Care Program Involving an Advanced Practice Nurse on 30-Day Hospital Readmissions for Elderly Patients Discharged From a Short Stay Geriatric Ward (PROUST Study)|
|Study Start Date :||July 2015|
|Estimated Primary Completion Date :||June 2017|
|Estimated Study Completion Date :||June 2017|
Experimental: Transitional care program.
The transitional care program from hospital to home will be implemented at three steps: during the patient's stay in hospital, the day of the discharge and during 4 weeks after discharge.
Other: Transitional care program.
During the patient's stay in hospital, the transition nurse creates a transitional care file including information about the patient (inpatient medical and nurse care plan, medications), the discharge plan, and the contact information of the relevant primary care providers. She notifies the patient's primary care physician of the date of the discharge to home, of the potential medical problems and of the discharge care plan; a primary care physician visit is planned the month following the discharge.
The day of the hospital discharge: meeting with the patient to review the follow-up recommendations. The transition nurse verifies that the medications are prescribed accordingly with the discharge plan, that the patient and his caregiver understand the prescription and are informed with the planned appointments and the biological monitoring.
During 4 weeks after the hospital discharge: follow-up by the transition nurse once a week, alternately by telephone and home visit.
standard care program
No intervention liable to affect the care provided to the patients, the organization of care or the practices of health care professionals will be implemented during the control period (time steps without intervention).
Other: standard care program
The patients will be discharged according to the usual care plan of each participating hospital. The medical team does a medical and geriatric assessment of the patients according to the recommendations. The communication of information to the primary care providers (nurse, primary care physician…) is left to the discretion of the medical teams of the discharging hospitals, according to their habits of work.
- 30-Day unscheduled hospital readmission or emergency visit rate after the index hospital discharge. [ Time Frame: Within 30 days after hospital discharge. ]Unscheduled hospital readmissions are hospitalizations that are not planned at the moment of the discharge (for example: hospitalization after an emergency visit or upon request of the primary care physician).
- Length of stay in the short stay geriatric ward (index hospitalization) [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average between 2 days and 30 days ]
- Unscheduled hospital readmissions or emergency room visits [ Time Frame: Within 30 and 90 days after the index hospital discharge. ]
- Free-hospitalization survival [ Time Frame: Within 30 and 90 days after the index hospital discharge. ]
- Mortality rate [ Time Frame: Within 30 and 90 days after the index hospital discharge. ]
- Adverse events (i.e. falls) [ Time Frame: Within 30 days after the index hospital discharge. ]
- Quality of life. [ Time Frame: Within 30 days after the index hospital discharge. ]Measured with the French version of the EUROQOL-5D.
- Patients' satisfaction care transition programme [ Time Frame: Within 30 days after the index hospital discharge. ]Measured with the Care Transition Measure® questionnaire.
- Delay between the index hospital discharge and the implementation of home care. [ Time Frame: Within 30 days after the index hospital discharge. ]
- Number of contacts between the transition nurse and the primary care providers or the hospital providers after discharge [ Time Frame: Within 30 days after the index hospital discharge. ]
- Costs of unscheduled hospital readmission or emergency visit [ Time Frame: 30 days after discharge ]Hospital and community care costs after discharge
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): NCT02421133
|Contact: Thomas Gilbertfirstname.lastname@example.org|
|Contact: Stéphanie Poupon Bourdyemail@example.com|
|CH Gériatrique des Monts d'Or||Recruiting|
|Albigny sur Saône, France, 69250|
|Contact: Jean-Stéphane Luiggi +334 72 08 15 31 firstname.lastname@example.org|
|Bourg en Bresse, France, 01012|
|Contact: Jacquet-Francillon +334 74 45 40 36 email@example.com|
|Centre Hospitalier Alpes Léman||Recruiting|
|Contamine sur Arve, France, 74130|
|Contact: André DARTIGUEPEYROU|
|Hôpital Édouard Herriot||Recruiting|
|Lyon, France, 69437|
|Contact: Brigitte Comte +334 72 11 95 60 firstname.lastname@example.org|
|Hôpital Édouard Herriot||Recruiting|
|Lyon, France, 69437|
|Contact: Michel Chuzeville +334 72 33 34 32 email@example.com|
|Centre Hospitalier Lyon Sud||Recruiting|
|Pierre Benite, France, 69495|
|Contact: Marc Bonnefoy +334 78 86 15 81 firstname.lastname@example.org|
|Sub-Investigator: Thomas Gilbert|
|Pringy, France, 74374|
|Contact: Debray +334 50 63 66 10 email@example.com|
|Saint Chamond, France, 42400|
|Contact: Magali Tardy +334 77 31 19 19 firstname.lastname@example.org|
|Clinique des portes du sud||Recruiting|
|Venissieux, France, 69200|
|Contact: Basile Turkie +334 27 85 21 16 email@example.com|
|Villefranche, France, 69655|
|Contact: Max Haine, Dr|
|Principal Investigator:||Marc Bonnefoy||Centre Hospitalier Lyon Sud-Hospices Civils de Lyon|