Effect of Strategies to Improve General Practitioner-nurse Collaboration and Communication

Study Overview
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Brief Summary
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Previously,six measures were developed for a better collaboration of general practitioners and nurses in nursing homes in a qualitative multistep bottom-up process. These measures, summarised as the interprof ACT intervention, shall improve the flow of information and the communication between the involved parties and lead to more transparency and effectiveness regarding treatment decisions of nursing home residents.The major aim of this trial is to examine the clinical effectiveness of interprof ACT. The main hypothesis is that implementation of interprof ACT reduces the cumulative incidence of hospitalisations of nursing home residents within 12 months from 50% to 35% (15% absolute reduction).

Official Title
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Effects of Strategies to Improve General Practitioner-nurse Collaboration and Communication in Regard to Hospital Admissions of Nursing Home Residents.

Conditions
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Utilization of Medical Care by Nursing Home Residents

Intervention / Treatment
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* Procedure: interprof ACT measures


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Residents: at least one GP visit in recent three months or two GP visits in recent 6 months or admission to the nursing home during the precedent 6 months independently of documented GP contacts at least 18 years of age written informed consent by the resident or her/his legal guardian Inclusion Criteria Nursing Homes: minimum size of 40 residents written consent provided by the nursing home Manager Prior to randomisation Exclusion Criteria Residents: - admission for short term care only Exclusion Criteria Nursing Homes: - participation in other projects on interprofessional collaboration.

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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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control Group<br>Care of nursing home residents as usual. | |
| Experimental: Interventional Group<br>Implementation of interprof ACT measures to improve collaboration and communication between general practitioners and nursing staff. Measures are selected and adapted by nursing home management / nurses, GPs and residents' relatives or representatives. | Procedure: interprof ACT measures<br>* Definition of common goals between general practitioner and nursing staff, appointment of a contact person, support in assigning medication, use of name badges worn by GPs and nurses during visits, mandatory availability of contact person, standardized procedures for GPs home visits<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cumulative number of hospitalisation | Cumulative incidence of hospitalisations from nursing home residents within 12 months | within 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| absolute number of hospitalisations | number of hospitalisations within 12 months | within 12 months | 
| hospital days | Hospital days within 12 months | within 12 months | 
| mortality | mortality within 12 months | within 12 months | 
| potentially inadequate medications | potentially inadequate medications at baseline and for follow-ups at 6 and 12 months | baseline and after 6 and 12 months | 
| Adverse Events | Adverse Events within 12 months | within 12 months | 
| Quality of Life in Alzheimer's Disease scale - Nursing Home version (QoL-AD-NH) | Residents' quality of life at baseline and at 12 months. Scale range is 15 - 60, with higher scores indicating higher QoL. | baseline and after 12 months | 
| Health-related Quality of Life (HRQL) of residents measured by EQ-5D-5L | The EQ-5D-5L consist of two self-rating components: the EQ-5D descriptive system and a visual analogue scale (EQ VAS). The EQ-5D descriptive system measures HRQL on the five dimensions mobility, self-care, usual activities, pain / discomfort and anxiety / depression. On each dimension participants can rate either no problems (0), slight problems (1), moderate problems (2), severe problems (3) or extreme problems (4), resulting in a score ranging from 0 (best) to 4 (worst). The scores of the single dimensions can be combined to a sum score ranging from 0 (best) to 20 (worst). In addition, so called utility weights can be attached to any possible combination of answers on the EQ-5D descriptive system which results in a utility score ranging from 0 (death) to 1 (full HRQL), which is then used to calculate quality-adjusted life years (QALYs). The EQ VAS ranges from 0 (worst imaginable health state) to 100 (best imaginable health state). | baseline and after 12 months | 
| medical services | use of other medical services within 12 months | within 12 months | 
| economic evaluation: efficiency | economic evaluation: efficiency (incremental cost-effectiveness ratio) and cost savings from payer and societal perspective | after 12 months | 
| Quality of inter-professional collaboration according to the Partnership Self-Assessment Tool (PSAT) score | Higher score values indicating better collaboration. | after 12 months | 
| Attitudes towards inter-professional collaboration according to the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAPNC) score | Higher score values indicating more favourable attitudes. | after 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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nursing home residents, interprofessional collaboration, reduction of hospitalisation