Clinical trial NCT04873973: Optimized Acute Care for Geriatric Patients Using an Intersectoral Telemedical Cooperation Network - Around the Clock - Technical Performance
Official title: Optimized Acute Care for Geriatric Patients Using an Intersectoral Telemedical Cooperation Network - Around the Clock - Technical Performance
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Emergencies
Keywords: telemedicine
geriatric
early warning score
acute care
nursing home
emergency department
Lead sponsor: RWTH Aachen University
Sponsor class: OTHER
Collaborators: name: Optimal@NRW Research Group
First posted: 2021-05-05
Enrollment: 3073
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Stepped-Wedge-Design
Primary purpose: OTHER

Brief summary: Due to "demographic change", the composition of the population in Germany is changing. The consequence of this change is a population that is getting older on average. A key challenge is the appropriate nursing and medical care of older people in senior residences and care facilities. The increasing workload for nursing staff and doctors in the outpatient sector means that timely care for patients, e.g. in the form of GP visits, cannot always be guaranteed in a timely manner. The results are unnecessary or premature hospital admissions as well as ambulance and emergency care interventions, even though in many cases it is not an acute or even life-threatening event. Furthermore, it has been scientifically proven that hospital admissions can increase the risk of patients becoming confused. The aim of this project is to avoid unnecessary hospital admissions and to enable patients to remain in their familiar surroundings as far as this appears medically justifiable. At the same time, the study aims to improve the medical care of nursing home residents through better networking of medical areas, the use of tele-consultations and an early warning system.

Detailed description: The Optimal@NRW project represents a new cross-sectoral approach to the acute care and support of geriatric people in need of care through the implementation of an early warning system and the integration of a telemedical consultation system in 25 nursing homes in the region of Aachen in Germany. The project focuses on restructuring emergency care in nursing homes and improving cooperation between the actors involved (emergency service, emergency department, general practitioners, nursing staff, etc.). Accordingly, a central emergency number of the statutory health insurance funds is to act as a virtual hub for the care of geriatric patients.

The concrete approach of the project is that the participating nursing homes first contact the medical call centre (116 117) in case of a medical problem. The call centre is then responsible for an initial medical assessment and decides whether the respective GP can be called in or whether a teleconsultation with the "virtual digital desk" (i.e. the medical experts from the emergency department of the University Hospital RWTH Aachen) should be carried out. In addition, mobile nursing assistants (NÄPÄ (Z)) will be introduced as part of the project, who can also support the nursing staff and provide services that can be delegated by doctors - especially if the general practitioner is not available at the time.

In addition, a standardised early warning system is to be established in the nursing homes and its benefits evaluated. This will enable potentially dangerous changes in the state of health of nursing home residents to be detected earlier.

The unique and novel development of the technical concept and the interaction between a central electronic patient record, an early warning system and the telemedical equipment plays a decisive role in the success of the project.

Eligibility criteria: Inclusion Criteria:

* Resident of one of the participating nursing homes
* At least 18 years old
* Written informed consent
* Consent of the guardian for residents who are not legally able to give consent

Exclusion Criteria:

* Persons placed in an institution by order of an authority or court
* Persons who are in a dependent or employment relationship with the investigator

Primary outcomes:
measure: Number of non-realized teleconsultations by request
timeFrame: 6 to 15 months depending on the cluster affiliation
Secondary outcomes:
measure: Number of system crash while running a teleconsultation
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Number of incorrect data transmissions within the overall system
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Duration until the realization of a teleconsultation
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Number of causes that lead to system crash
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Data transmission rate requirement
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Rate of complications of the early warning system in connection with telemedicine
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the early warning system
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the early warning system
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the early warning system
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the early warning system
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the early warning system
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the teleconsultation equipment
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the teleconsultation equipment
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the teleconsultation equipment
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the teleconsultation equipment
timeFrame: 6 to 15 months depending on the cluster affiliation
measure: Performance of the teleconsultation equipment
timeFrame: 6 to 15 months depending on the cluster affiliation
Other outcomes:
measure: Satisfaction survey
timeFrame: 24 months
measure: Ethic survey
timeFrame: 24 months
measure: Acceptance survey
timeFrame: 24 months
measure: Usability survey
timeFrame: 24 months
Locations:
city: Aachen
country: Germany
facility: University Hospital RWTH Aachen
Study officials:
affiliation: Uniklinik RWTH Aachen
name: Jörg Christian Brokmann, PD Dr. med.
role: PRINCIPAL_INVESTIGATOR
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