Telemedicine Makes the Patient Stay in Hospital at Home

Study Overview
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Brief Summary
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The goal of the project is to study whether multidisciplinary follow- up performed via telemedicine to the patient in his or her own home, will improve the healthcare services offered to a particular group of patients. The hypotheses are that this could increase the treatment options, increase knowledge translation, give significant socioeconomic benefits, and allow greater accessibility to specialized healthcare services, as well as increase the involvement of patients and those working in primary healthcare.

Detailed Description
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The goals of rehabilitation are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. The costs associated with pressure injury are considerable. In addition to direct treatment- related costs, pressure injury also impact the hospital performance metrics. On top of the financial implications, pressure injury have a significant impact on patient morbidity and -mortality, as well as on health related quality of life. The researchers believe there is a large potential for improvement in treatment of pressure injuries. An multidisciplinary approach, including home-based rehabilitation programs, might help prevent pressure injuries and their complications, and thus reduce associated costs. The investigators conducted a pilot in 2012, in which patients with spinal cord injury and pressure injury were monitored through multidisciplinary outpatient home care, using telemedicine. The project was beneficial for the consumers/ patients, especially in terms of consumer- participation and -contribution, improved quality of life, and a better cooperation between primary and specialized healthcare services. Retrospective economic analysis indicated that telemedicine provides great savings for public healthcare services, and that using telemedicine with other patient groups with similar problems, could be beneficial. A positive outcome of the current study can be made available to most people with pressure injury. Knowledge about pressure injury will contribute in both planning and establishment of good treatment lines for the patients, as well as contribute to environmental savings, and more proper use of the health resources. This may reduce the consumption of hospital services, because a larger proportion of services are provided by the municipality. An important scientific significance of this research will thus be to improve, simplify and streamline health care and health- related services.

Official Title
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Telemedicine Makes the Patient Stay in Hospital at Home. Service Innovation With Focus on Multidisciplinary Collaboration

Conditions
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Spinal Cord Injury, Pressure Injury

Intervention / Treatment
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* Other: Service innovation with focus on multidisciplinary collaboration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Traumatic or non- traumatic SCI and ongoing pressure injury. Consent to participate. Exclusion Criteria: Patients who are unable to give their consent due to cognitive problems. Patients who do not have a permanent/ known address.

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention, telemedicine and multidisciplinary cooperation<br>The intervention group will be offered regular multidisciplinary outpatient follow-up via telemedicine. | Other: Service innovation with focus on multidisciplinary collaboration<br>* The follow-up is performed via telemedicine (videoconference) to the patient in his or her own home, and in cooperation with the district nurses.<br>* Other names: Telemedicine in outpatient follow-up;|
| Active Comparator: Control, multidisciplinary guidance on request.<br>The control group will receive guidance based on existing routines (on-site consultations at the wound clinic and telephone consultations), and based on initiative taken by the local healthcare service/ patient/ next of kin. | Other: Service innovation with focus on multidisciplinary collaboration<br>* The follow-up is performed via telemedicine (videoconference) to the patient in his or her own home, and in cooperation with the district nurses.<br>* Other names: Telemedicine in outpatient follow-up;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health related quality of life | Measured by the use of SF-36, EQ-5D and SCI QoL BDS | 1 year | 
| Wound healing | The reduction of pressure injury size will be measured in percentage and time to healing as days from baseline to healing | 1 year | 
| Cost-utility | Measured in Euro, by use of QUALYs and ICER in a CE plane | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Experienced interaction, satisfaction and safety in the follow-up | Measured by use of a custom made Likert scale with 1 being completely dissatisfied and 5 being totally satisfied | 1 year | 
| Environmental evaluation | Measured in terms of travel distance, travel time used and travel costs by use of The Michelin Travel's Route Planner. Environmental emission due to the travel will be measured in terms of Carbon Oxide values, called CO2 equivalents | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Spinal Cord Injury, Pressure Injury, Health Related Quality of Life, Telemedicine, Service Innovation, Rehabilitation, Interdisciplinary collaboration, User-participation, Activity and participation, Health economics