Please select the eligibility criteria that correspond to the clinical trial below.
Title: Nurse-led Care Model in Swiss Nursing Homes: Improving INTERprofessional CARE for Better Resident Outcomes (INTERCARE)
Brief Summary: This implementation science project aims to implement a nurse-led model of care in 11 nursing homes in the German speaking part of Switzerland, to reduce avoidable hospitalisations. The model will be introduced using a non-randomized stepped-wedge design. First, training will be delivered to leadership teams and to geriatric nurse experts, secondly after a baseline measurement period, including distribution of questionnaires and collection of resident data mainly national quality indicators and data regarding hospitalisations, the nurse led model will be implemented and thereafter 2 measurement periods will follow (6 months after the beginning of the intervention and at the end). Quantitative resident data will be retrieved from the RAI-NH three-monthly, and hospitalization data with the help of a data platform, reflection tools and hospital discharge reports continuously from the baseline period until the end of the data collection in 02.2020. The hypotheses of the project are:

* To assess the effectiveness of the nurse-led care model on unplanned hospitalizations (primary outcome) and additional resident and staff outcomes, hypothesizing that nursing homes with a nurse-led care model have lower rates of unplanned hospitalizations and show improvements in additional resident and staff outcomes
* To assess the effect of the degree of adoption on client outcomes, hypothesizing that a higher degree of adoption is related to better client outcomes
* To describe the implementation costs the Swiss nurse-led interprofessional NH care model on the NH level and to assess the economic impact of INTERCARE with a cost-effectiveness analysis adopting a health care system perspective (comparing the increase in staff costs with the decrease of days of avoidable hospitalizations)
* To explore resident/family and staff perceptions of service outcomes (e.g., timeliness) and the acceptability of the nurse-led care model;
* To describe the degree to which the model was adopted, its feasibility, the fidelity with which it was applied, and the barriers and facilitators met by NH leadership and nurse experts.


Options:
A: Inclusion Criteria:

* Resides within either a 5-mile or 20 minute driving radius of emergency department
* Has capacity to consent to study OR can assent to study and has proxy who can consent
* \>= 18 years-old
* Can identify a potential caregiver who agrees to stay with patient for first 24 hours of admission. Caregiver must be competent to call care team if a problem is evident to her/him. After 24 hours, this caregiver should be available for as-needed spot checks on the patient. This criterion may be waived for highly competent patients at the patient and clinician's discretion.
* Primary or possible diagnosis of cellulitis, heart failure, complicated urinary tract infection, pneumonia, COPD/asthma, other infection, chronic kidney disease, malignant pain, diabetes and its complications, gout flare, hypertensive urgency, previously diagnosed atrial fibrillation with rapid ventricular response, anticoagulation needs, or a patient who desires only medical management that requires inpatient admission, as determined by the emergency room team.

Exclusion Criteria:

* Undomiciled
* No working heat (October-April), no working air conditioning if forecast \> 80°F (June-September), or no running water
* On methadone requiring daily pickup of medication
* In police custody
* Resides in facility that provides on-site medical care (e.g., skilled nursing facility)
* Domestic violence screen positive
* Acute delirium, as determined by the Confusion Assessment Method
* Cannot establish peripheral access in emergency department (or access requires ultrasound guidance)
* Secondary condition: end-stage renal disease, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage
* Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control
* Cannot independently ambulate to bedside commode
* As deemed by on-call medical doctor, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery
* High risk for clinical deterioration
* Home hospital census is full (maximum 5 patients at any time)
B: Inclusion Criteria:

Nursing homes

* German-speaking
* Size: ≥80 long-term care beds (NHs with \>60 beds will be considered if they have a high hospitalisation rate)
* Hospitalisation rates: ≥0.8/1000 resident days

Residents

- All long-term care residents

Geriatric nurse experts:

* Registered nurse
* At least three years' experience in long-term care

Nursing home staff

* Care workers of all educational levels, including students
* Other health professionals employed by the NH (such as therapists, dieticians) with direct resident contact
* Employed by the NH and working in the NH for a minimum of 3 months

Exclusion Criteria:

Nursing homes

* Italian-speaking
* French-speaking

Residents

- Short term or day care residents, other residents with a discharge planned within two months after admittance
C: Inclusion Criteria:

* Adult patients, 18 years of age and older.
* Present to one of the participating hospitals.
* Have a chief complaint of one of the target diagnoses.
* Are within a certain geographical area (based on zip codes).
* Have a health insurance plan that covers ACH services.
* Have the capacity to consent or could assent with the consent of a health care proxy who is physically present.

Exclusion Criteria:

* The patient is not suitable for ACH or inpatient hospital care based on:

  * being a nursing home patient;
  * on or requiring dialysis;
  * positive for COVID-19;
  * having discharge order;
  * requiring intensive care unit (ICU) level of care;
  * history of drug abuse.
* Patients will also need to meet the clinical stability criteria.
* Do not have the capacity to consent or assent with the assistance of a health care proxy.
D: Inclusion Criteria:

* Confirmed stroke according to WHO´s criteria
* \> 18 years of age
* Living within 30 min from the stroke unit
* On day 2 NIHSS (National institute of health stroke scale) (22) of 0-16 points and Barthel 50-100 points.
* MoCA index \< 26 if Barthel = 100.

Exclusion Criteria:

* NIHSS \> 16
* Barthel \< 50
* Life expectancy \< 1 year (as with severe malignancy)
* Does not speak or communicate in Swedish prior to the incidence

Answer: B