Multidisciplinary Mobile Unit for Preventing Hospitalization of Nursing Home Residents (MMU-1)
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|ClinicalTrials.gov Identifier: NCT04085679|
Recruitment Status : Terminated (The local Healthcare authorities extended the planned intervention to all nursing homes of the district after the emergence of multiple outbreaks of severe COVID-19 in several nursing homes.)
First Posted : September 11, 2019
Last Update Posted : January 14, 2021
Elderly patients residing in nursing homes are particularly at risk of experiencing urgent medical problems needing admission to the Emergency Department (ED). This circumstance contributes to ED overcrowding, increases the risk of ward admission of elderly patients, and puts them at an even higher risk of hospitalization-related adverse events. The study hypothesis is that a complex intervention, delivered directly in nursing homes by hospital physicians in case of urgent medical problems, would contribute to reduce hospitalization of older nursing home residents.
The intervention consists in a hospital-based "multidisciplinary mobile unit" (MMU), composed of a hospital specialist and a resident in emergency-urgency medicine who are coordinated by a senior physician serving as "flow manager". The team is active on work days, 8 am to 6 pm, and is activated by general practitioners of nursing homes, in case of urgent medical needs of one of the residents. The activation is made by a phone call to the "flow manager", who triages the clinical needs of the case. The output of the phone consultation may include therapeutic advice provided by phone, immediate on-site visit by the MMU team (specialist and resident), scheduled visit by the MMU team, or direct admission to the hospital unit where MMU is based, avoiding ED visits. The MMU team is provided with a portable ultrasound system, an essential set of drugs and medical devices useful in a urgency setting (central venous lines, nasogastric tubes, rectal tubes, bladder catheters). During on-site visits, the MMU team performs diagnosis, stabilization and therapeutic advice, with the mission of avoiding ED visits and hospital admissions whenever possible.
The MMU intervention is already active in two nursing homes, since December 2018. The aim of this prospective, pragmatic, multicenter, quasi-experimental study (sequential design with two cohorts) is to test the effects of the implementation of the MMU care model in terms of reduction of unplanned hospitalization rates (primary outcomes), mortality, health service use and costs (secondary outcomes).
Two nursing homes (i.e., the ones who already benefit from the intervention) will serve as study group, and two nursing homes with similar geographical location will serve as control group. All residents of the participating nursing homes will be eligible for study inclusion. The study will last for 18 months, and a number of 338 residents is planned for inclusion.
|Condition or disease||Intervention/treatment|
|Frailty Disability Multimorbidity Respiratory Failure Abdominal Pain Infection||Other: Multidisciplinary Mobile Unit (MMU)|
|Study Type :||Observational|
|Actual Enrollment :||13 participants|
|Official Title:||Implementation of a Strategy to Prevent Hospital Admission in Nursing Home Residents: Protocol of a Quasi-experimental Study|
|Actual Study Start Date :||January 15, 2020|
|Actual Primary Completion Date :||December 30, 2020|
|Actual Study Completion Date :||December 30, 2020|
MMU active group
Subjects residing in nursing homes where the MMU care model has already been implemented
Other: Multidisciplinary Mobile Unit (MMU)
MMU is called in case of urgent clinical situations involving patients residing in nursing home
MMU control group
Subjects residing in nursing homes where the MMU care model has not yet been implemented (ED visits performed in case of urgent clinical situations)
- Hospitalization rate [ Time Frame: 1 year ]Calculated as all unplanned admissions divided per the sum of the person-time of the at-risk population (days of stay at the nursing home)
- Crude all-cause death [ Time Frame: 1 year ]Number of deaths on person-time of the at-risk population
- Hospital mortality rate [ Time Frame: 1 year ]The frequency of patients dead while in hospital (death rate/1000)
- Length of hospital stay [ Time Frame: 1 year ]Duration of a single episode of hospitalization, with inpatient days calculated by subtracting day of admission from day of discharge
- Adverse events or complications [ Time Frame: 1 year ]Frequency of events occurred within 48 hours from MMU team activation and subsequent patient stabilization, for which hospital access becomes necessary
- Cost analysis [ Time Frame: 1 year ]Hospitalization-related costs
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): NCT04085679
|UO Medicina Interna e Lungodegenza Critica, Azienda Ospedaliero-Universitaria di Parma|
|Parma, Emilia-Romagna, Italy, 43126|
|Principal Investigator:||Tiziana Meschi, M.D.||Azienda Ospedaliero-Universitaria di Parma (Parma University Hospital)|