An ESD Model of Care for Older Adults Admitted to Hospital: a Protocol for a Descriptive Cohort Study

Study Overview
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Brief Summary
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The MidWest multidisciplinary Community Intervention Teams (MD-CIT) comprise of specialist, healthcare teams that provide a rapid and integrated response to a patient with an acute episode of illness who requires enhanced services/acute intervention for a defined short period of time in the MidWest of Ireland. This is provided in the patient's home, thereby facilitating early discharge from the acute hospital setting. The investigators are performing an evaluation of the MDCIT service provided to older adults admitted to UL Hospitals Group. The investigators will assess patients in hospital, at 30 days and at a six months.

Official Title
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An Early Supported Discharge Model of Care for Older Adults Admitted to Hospital: a Protocol for a Descriptive Cohort Study

Conditions
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Aging, Function, Hospitalization

Intervention / Treatment
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* Other: MDCIT Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Older adults ≥ 65 years who are discharged home (community dwelling) from ULHG with a referral to the MDCIT service between December 2022 and June 2023 will be deemed eligible for recruitment Exclusion Criteria: Those aged < 65 years discharged home from ULHG and referred to the MDCIT service Those deemed to not have decision making capacity to provide informed consent

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: MDCIT Intervention|The MidWest Multidisciplinary Community Intervention Teams (MDCIT) comprise of specialist, healthcare teams that provide a rapid and integrated response to a patient with an acute episode of illness who requires enhanced services/acute intervention for a defined short period of time. This is provided in the patient's home after an acute hospital admission, thereby facilitating early discharge. The MDCIT intervention is composed of occupational therapy, physiotherapy, and healthcare assistants, with nursing support as required. The MDCIT therapists aim to make their first visit to patients within 24-48 hours of hospital discharge. Patients receive two-three visits per week, over a period of two to four weeks dependant on the patient's rehabilitation needs. Upon discharge from the MDCIT service, patients can be referred to community services as indicated by therapists.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional Ability | Function will be measured using the Barthel Index (BI). The BI scores a patient from 0-20, with a higher score indicating greater independence. | This will be measured at baseline. | 
| Functional Ability | Function will be measured using the Barthel Index (BI). The BI scores a patient from 0-20, with a higher score indicating greater independence. | This will be measured at 30 days. | 
| Functional Ability | Function will be measured using the Barthel Index (BI). The BI scores a patient from 0-20, with a higher score indicating greater independence. | This will be measured at 180 days. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frailty Score | Frailty will be measured using the Clinical Frailty Scale (CFS). The CFS screens for frailty in older adults, with a minimum score of 1 considered least frail and a maximum score of 9 indicating severe frailty. | This will be measured at baseline. | 
| Frailty Score | Frailty will be measured using the Clinical Frailty Scale (CFS). The CFS screens for frailty in older adults, with a minimum score of 1 considered least frail and a maximum score of 9 indicating severe frailty. | This will be measured at 30 days. | 
| Frailty Score | Frailty will be measured using the Clinical Frailty Scale (CFS). The CFS screens for frailty in older adults, with a minimum score of 1 considered least frail and a maximum score of 9 indicating severe frailty. | This will be measured at 180 days. | 
| Patient Quality of Life | Quality of Life will be measured using the EQ-5D-5L. This questionnaire asks a patient to rate their overall perceived health from a scale of 0-100 (0 = very poor; 100 = excellent). | This will be measured at baseline. | 
| Patient Quality of Life | Quality of Life will be measured using the EQ-5D-5L. This questionnaire asks a patient to rate their overall perceived health from a scale of 0-100 (0 = very poor; 100 = excellent). | This will be measured at 30 days. | 
| Patient Quality of Life | Quality of Life will be measured using the EQ-5D-5L. This questionnaire asks a patient to rate their overall perceived health from a scale of 0-100 (0 = very poor; 100 = excellent). | This will be measured at 180 days. | 
| Quality of Care | Quality of Care will be measured using the Patient Assessment of Integrated Elderly Care. Patients are asked 20 questions across a Likert scale from 'none at all' to 'always.' | This will be measured at 30 days. | 
| Quality of Care | Quality of Care will be measured using the Patient Assessment of Integrated Elderly Care. Patients are asked 20 questions across a Likert scale from 'none at all' to 'always.' | This will be measured at 1800 days. | 
| Unscheduled ED Attendance(s) | ED hospital databases will be searched to identify ED attendances. | This will be measured at 30 days. | 
| Unscheduled ED Attendance(s) | ED software will be searched to identify ED attendances. | This will be measured at 180 days. | 
| Unscheduled Hospital Admission(s) | ED and hospital software will be searched to identify admissions. | This will be measured at 30 days. | 
| Unscheduled Hospital Admission(s) | ED and hospital software will be searched to identify admissions. | This will be measured at 180 days. | 
| Nursing Home Admission(s) | Hospital software will be searched to identify patients admitted to nursing homes. | This will be measured at 30 days. | 
| Nursing Home Admission(s) | Hospital software will be searched to identify patients admitted to nursing homes. | This will be measured at 180 days. | 
| Mortality | Hospital software will be searched to identify patients who pass away. | This will be measured at 30 days. | 
| Mortality | Hospital software will be searched to identify patients who pass away. | This will be measured at 180 days. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hospitalised, patient discharge, older adults, early supported discharge, cohort study