Capturing Readmission Internationally to Prevent Readmission by Safer@Home Group

Study Overview
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Brief Summary
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CURIOS@ is a prospective multi-centre cross-sectional study to investigate readmissions in participating units. The data collected is derived from two clinical episodes: the episode containing the re-admission and the previous admission (index admission). The main aims are: Outcomes: Risk factors to predict preventable readmissions in non-surgical patients Percentage of subjectively non-preventable and preventable readmissions from patient, carer, their nurses and their physician's point of view Comparison for risk factors on readmissions throughout Europe Increasing awareness and knowledge for health-care workers on readmissions and its preventability

Detailed Description
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Data will be derived directly from patients, from the clinical notes of the previous admission and records of discharge communication. Also information from treating physicians, nurses and immediate caregivers will be collected. The data set will contain no directly identifiable variables (data will be registered by using a research code for each patient). Data collection will include: Hospital-related data, patient-related data, health-related data, time-related data, and physician related data. Also patient feedback is requested. After obtaining written informed consent, the researcher will ask the patient 7 questions about the (preventability of their) readmission. Also the patient will be asked if one of the direct carers can be approached with 2 questions. The carer will most often be a sibling, a good friend or someone from the neighborhood. We will approach the carer in person or by telephone, and only after explicit permission from the patient. Lastly, we will ask a doctor and nurse (responsible for the patient in the first 24 hours of his readmission) similar questions.

Official Title
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Capturing Readmission Internationally to Prevent Readmission by Safer@Home

Conditions
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Hospital Readmission

Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Adult patients aged 18 or above admitted to hospital as unscheduled medical admission for a minimum of a single night following a previous admission within 30 days Index admission can be for any procedure (elective/non-elective) Index admission at any hospital ward (except psychiatry, pediatrics or gynaecology) for a minimum of a single night during the previous 30 days Readmission should be to a medical ward (Medical ward: Cardiology, geriatrics, gastroenterology, hematology, internal medicine, nephrology, neurology, oncology, pulmonary medicine, rheumatology.) If a patient is readmitted more than once within the study period, only the first readmission will be included The port of entry is through an Emergency Department, Acute Medical Unit or any other clinical ward (i.e. department of internal medicine). Patients should all be capable of understanding the study and give written informed consent. They should all be mentally competent. Exclusion criteria: Patients readmitted electively for procedures, surgery or chemotherapy Patients readmitted for a non-medical specialism (surgery, urology, ent etc..) Patients admitted or readmitted who are pregnant Patients admitted or readmitted aged under 18 Patients index or readmission for pediatrics, psychiatry, gynaecology Patients who stayed less than one night during index and readmission Patients who have been admitted to another institution in their index admission (To facilitate timely case identification and ready access to treating physicians, we will only review same-hospital readmissions) A second readmission for the same patient within the study period

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of readmissions deemed preventable by patients, their informal carers, nurses and physicians | Of all the readmissions in the study, we will look at the readmissions which are deemed potentially preventable (YES or NO) by all partners of care chain. In the end this will give us a percentage of readmissions judged as potentially preventable by all partners of care chain. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Causes of preventable readmissions | We will ask all partners in the care chain about the causes of the readmissions. These will be categorised: Disease-related: Natural progress disease, out of control/influence physician or patient - for example: metastasis cancer. Patient-related: Related to control/influence patient, out of control/influence professionals - for example: a patient who refused extra home care after the index admission. Human/caregiver-related: Related to the control/influence professionals - for example: poor medication handover after index inclusion. Organisational: Readmission related to organisational problems - for example: no beds available, transfer from other hospital etc. Technical: Readmission related to technical defects of materials or equipment - for example: IV-drip home infusion antibiotics broken. | 1 year | 
| Risk factors for preventable readmissions | For every readmission, we will ask researchers to fill out a dataset with potential risk factors. These are: General data regarding readmission: i.e. length of stay, time between index admission and readmission. Patient-related factors: i.e. age, sex, marital status, living situation etc. Health-related: ie. comorbiditity, frailty score, polypharmacy etc. Time-related: i.e. Total admissions in previous year Physician related: i.e. was a discharge letter send? | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Preventability