Digital Support for Quality Assurance in 24-hour Caregiving at Home

Study Overview
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Brief Summary
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Due to the demographic change, there is a growing demand for professional and institutional care, as well as the need for 24-hour home care. Care receivers range from elderly people, in need of assistance with household activities only, to those with a comprehensive need for round-the-clock care. Caregivers commute between Austria and their respective home country (mainly Slovakia, Hungary and Romania) in a two or more weeks cycle. Burdensome working conditions arise mainly due to language problems, isolated coexistence with a person affected by e.g. dementia, in combination with limited professional education and quality control. The aim of the project is the development and evaluation of a software solution for the support and quality assurance of 24-hour home care. The application software contains: an information and education portal (e-learning platform) a comprehensive electronic care documentation an integrated emergency management links to translation pages or networking opportunities with members and relatives

Detailed Description
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Due to the demographic change, there is a growing demand for professional and institutional care, as well as the need for 24-hour home care. Due to the cost-efficiency and 24-hour availability, the 24-hour home care represents a cornerstone of the care of older people and, with more than 60.000 users in Austria, it represents an important alternative to family assistance and mobile care. Care receivers range from elderly people, who only need assistance with household activities, to those with a high need for a round-the-clock care. Caregivers commute between Austria and the respective home country (mainly Slovakia, Hungary and Romania) for the care work in a two or more weeks rhythm. Burdensome working conditions arise mainly due to language problems, isolated coexistence with a person affected by e.g. dementia in combination with little to no relevant professional education and quality control. The aim of the project is the development and evaluation of a distributed client-server software solution for the support and quality assurance of 24-hour home care. The application software contains: an information and education portal (e-learning platform) with interactive learning content on common diseases and short videos on recurrent care situations in German, as well as in Slovak, Hungarian and Romanian as the most frequent languages of the caregivers. a comprehensive electronic care documentation that supports quality assurance and ensures transparency between people involved. an integrated emergency management, which offers caregivers the opportunity to react quickly and professionally to emergencies. links to translation pages or networking opportunities with members and relatives. By using the application software, the quality of care will be supported and further result in an increase of care quality and quality of life of the older adults cared for. Due to intense longitudinal evaluation design with more than 100 involved households facilitating 24-hour home care for a period of 12 months, the efficacy will be measured multi-dimensionally. Common surveys and structured interviews of people with cognitive impairments tend to lack sensitivity to the interventions studied. Hence, a mixed-method approach has been selected that integrates 1) investigator observations, 2) interviews with caregivers, 3) interviews with relative and 4) interviews with care receivers (where possible). Trained investigators generate reliable ratings via triangulation. Field work and analysis follows the methodology developed as Toolkit ASCOT (Adult Social Care Outcomes Toolkit 11) SCT4 (self completion survey).

Official Title
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Digital Support for Quality Assurance in 24-hour Caregiving at Home

Conditions
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Age Problem

Intervention / Treatment
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* Device: Intervention of parallel arm 2
* Device: Intervention of parallel arm 3


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Household with 24-hour-care service Household located in the federal territory of Austria Caregiver able and willing to comply with all study related procedures and giving informed consent Age 55+ years for care receivers Exclusion Criteria: Death of care receiver Termination of 24-hour-care, due to other reasons than death of care receiver Interruption of 24-hour-care for at least 8 weeks

Ages Eligible for Study
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Minimum Age: 55 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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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Three parallel arms investigate 1) the control group, where home care is being continued as before, 2) combined effects of the e-learning platform and the networking platform, and 3) effects of the entire intervention (e-learning platform, networking platform, digital care documentation). The interventions last 12 months, with effects being investigated in two follow-ups after three and 12 months. The main one-sided alternative hypothesis, assumes a positive trend from 1 ) towards 3) in the outcomes studied. Planned contrasts are: control vs. experimental arm 3 (indicating effects of the entire experimental intervention) arm 2 vs. arm 3 (indicating whether arm 3 has additional effects as compared to arm 2) Planned contrasts are ignored, if the overall null hypothesis is not rejected in the ANOVA.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control group<br>This arm is being provided with continued home care as it was before | |
| Experimental: E-learning platform & networking platform<br>This arm is being provided with the e-learning platform and networking platform as components of the 24-h-quAALity package | Device: Intervention of parallel arm 2<br>* This intervention consists of the e-learning platform and the networking platform from the newly developed client-server software solution 24-h-QuAALity. The e-learning platform offers concise evidence-based information on common clinical patterns, as well as examples of assistance, physical activity, nutrition and daily routine provided in the caregivers' mother tongues.The caregivers use the e-learning content according to the needs of their clients and their caring skills. After completing the e-learning courses they do a test to prove their knowledge. The networking platform supports caregivers in communicating with other caregivers and relatives of the care receiver, with special consideration of language barriers. The caregivers use the networking platform primarily to get information or exchange it, if there are uncertainties in the care.<br>|
| Experimental: Entire intervention<br>This arm is being provided with the entire intervention (e-learning platform, networking platform and digital care documentation) | Device: Intervention of parallel arm 3<br>* Intervention Description: This interventions represents the entire 24-h-QuAALity package consisting of the e-learning platform and networknig platform as specified under intervention 1 and the digital care documentation from the newly developed client-server software solution 24-h-QuAALity. The digital care documentation aims at supporting caregivers in managing their daily tasks and facilitates exchange with other health professionals and palliative supply. The caregivers use the care documentation every day. They describe the caring and household activities they have done by their clients. The integrated emergency management empowers caregivers with lifesaving first aid skills and knowledge including an integrated voice communication and emergency call system. The emergency management system is used by caregivers when an emergency happens in which life-threatening diseases have to be managed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ASCOT (Adult Social Care Outcome Toolkit) SCT4 value - Summary Score of eight ASCOT Domain Scores related to Care Receivers | Metric scale. Standardized metric score ranging from -0.17 to 1, where 0 is equivalent to dead and 1 is ideal. | Baseline | 
| ASCOT (Adult Social Care Outcome Toolkit) SCT4 value - Summary Score of eight ASCOT Domain Scores related to Care Receivers | Metric scale. Standardized metric score ranging from -0.17 to 1, where 0 is equivalent to dead and 1 is ideal.ASCOT Domain Scores related to Care Receivers | 3 Month Follow-Up | 
| ASCOT (Adult Social Care Outcome Toolkit) SCT4 value - Summary Score of eight ASCOT Domain Scores related to Care Receivers | Metric scale. Standardized metric score ranging from -0.17 to 1, where 0 is equivalent to dead and 1 is ideal.ASCOT Domain Scores related to Care Receivers | 12 Month Follow-Up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ASCOT (Adult Social Care Outcome Toolkit) SCT4 value - Summary Score of seven ASCOT Instrument for Caregivers Scores | Metric scale. Standardized metric score ranging from 0 to 1, where 1 is ideal. | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| Project specific self-rated satisfaction and usefulness related to electronic care documentation, professional skills and qualification, and interconnectedness and communication - Summary Score of 14 project specific questions for Caregivers | Metric scale. Standardized metric score ranging from 0 to 1, where 1 is ideal. | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| Project specific self-rated satisfaction and usefulness related to electronic care documentation, care quality and conditions, and interconnectedness and communication - Summary Score of 7 project specific questions for Relatives of Care Receivers | Metric scale. Standardized metric score ranging from 0 to 1, where 1 is ideal. | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| Project specific self-rated satisfaction and usefulness related to electronic care documentation, and interconnectedness and communication - Summary Score of 4 project specific questions for Nurses | Metric scale. Standardized metric score ranging from 0 to 1, where 1 is ideal. | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT (Adult Social Care Outcome Toolkit) SCT4 - Domain Score for Personal Cleanliness and Comfort related to Care Receivers | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 - Domain Score for Food and Drink related to Care Receivers | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 - Domain Score for Accommodation Cleanliness and Comfort related to Care Receivers | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 - Domain Score for Personal Safety related to Care Receivers | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| Domain Score for Social Participation and Involvement related to Care Receivers | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 - Domain Score for Occupation related to Care Receivers | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 - Domain Score for Control over Daily Life related to Care Receivers | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 - Domain Score for Dignity related to Care Receivers | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 Instrument for Caregivers - Domain Occupation | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 Instrument for Caregivers - Domain Control over daily life | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 Instrument for Caregivers - Domain Looking after yourself | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 Instrument for Caregivers - Domain Personal safety | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 Instrument for Caregivers - Domain Participation and involvement | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 Instrument for Caregivers - Domain Space and time to be yourself | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 
| ASCOT SCT4 Instrument for Caregivers - Domain Feeling supported and encouraged | 4-point scale, indicating (aimed for as closely as possible): 1...ideal, 2…no needs, 3…some needs, 4...high needs | Baseline, 3 Month Follow-Up, 12 Month Follow-Up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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elderly, 24-hour home care, e-learning, digital care documentation, emergency management, active and assisted living