Clinical trial NCT02677272: Factors Predisposing to Inappropriate Transfers of Nursing Home Residents to Emergency Departments
Official title: Factors Predisposing to Inappropriate Transfers of Nursing Home Residents to Emergency Departments
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Frail Elderly
Keywords: Nursing home
emergency department
inappropriate transfer
elderly
Lead sponsor: University Hospital, Toulouse
Sponsor class: OTHER
Collaborators: name: Agence Régionale de la Santé - Midi Pyrénées
name: Ministry of Health, France
First posted: 2016-02-09
Enrollment: 1040
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_ONLY
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All patients living in Nursing Home admitted in Emergency Department of the hospitals participating in the study during the inclusion period will be included in the study.

Brief summary: According to the data of our nursing homes (NH) research network (REHPA - Gérontopôle Toulouse, 345 nursing home in France), 13.5% of NH residents are hospitalized every 3 months or about 50% per year. These hospitalizations concern for half, transfers to emergency department (ED). Data from the literature and the PLEIAD study, conducted with 300 NH in France, confirm that intense flows between NH and ED. These studies also support the idea that these transfers to ED potentially expose some NH residents to iatrogenic complications, a risk of functional decline, an increased risk of mortality, and generate additional health costs. To transfer to ED residents who will benefit from emergency care and not to transfer to ED residents for whom this transfer generates a higher risk than the expected benefit is the goal to reach to guarantee the better quality of care for NH residents.

Inappropriate transfer to ED may be defined by the absence of somatic emergency and / or palliative care known before transferring to ED and / or the presence of advance directives of non-hospitalization in the resident's file. This is a clinical situation that could be managed by other means that the transfer to ED without loss of opportunity for the patient.

The primary objective of our study is to determine the factors predisposing NH residents to inappropriate transfer to ED.

Our hypothesis is that inappropriate transfers to the ED of NH residents are conditioned by factors accessible to interventions such as the organization of the NH care system or by improving the management of some diseases in NH. Investigators also hypothesize that the cost of inappropriate transfers to the ED is considerable. Acknowledgement of costs generated by inappropriate transfers to ED would allow policy makers to make strategic decisions to improve care system.

Detailed description: This is a retroprospective study conducted in sixteen hospitals in south-west of France. Inclusion will last one year, including 4 periods (one per season) of 7 days (24h / 24, including necessarily each day of the week). All the NH residents admitted in ED will be included. For each resident included, medical and non-medical data will be collected in 4 times: retrospectively before transfer to ED (=T0); and prospectively : at ED (= T1), in hospital services in case the patient is hospitalized (=T2) and at the patient's return to NH (=T3).

At T0 data collected will concern the NH and resident basis medical state, resident's medical state the week before transfer and resident medical state before transfer to ED.

At T3 data collected will concern the resident's return modality and his/her autonomy 7 days after his/her return

Time frame:

between T1 and T3 : mean expected duration will variate from few hours if the resident isn't hospitalized (ED visit) to an average 12.4 days, which is the average length of hospital stay of NH resident hospitalized after a transfer to ED (cf Pleiad study, Rolland 2012) plus 7 days as Investigators will collect T3's data 7 days after the NH resident's return to NH

Eligibility criteria: Inclusion Criteria:

* to live in a Nursing Home
* to be directly transferred from the NH to ED
* to have not previously been included in FINE study

Exclusion Criteria:

* to live in structures other than Nursing Home (i.e. sheltered housing, seniors' residences, housing homes, retirement homes, long-term care units)
* to live in the community
* to be transferred to ED from elsewhere than the NH
* to have previously been included in FINE study

Primary outcomes:
measure: Inappropriate transfer to ED of NH residents
timeFrame: Baseline (T1 = inclusion at ED): retro-prospectively by the group of experts
Secondary outcomes:
measure: Cost of the NH resident transfer to ED
timeFrame: 6 months before to 6 months after the transfer
measure: Avoidability of the NH resident transfer to ED
timeFrame: Baseline (T1 = inclusion at ED)
measure: NH resident's autonomy using Katz'ADL
timeFrame: Change at different time points: T0, T2 (up to 12 days,if concerned) and T3 (7 days after return to NH)
measure: Analysis of Medical prescription, with a focus on psychotropic drug
timeFrame: Change at different time points: T1 (baseline), T2 (up to 12 days,if concerned) and T3 (7 days after return to NH)
Other outcomes:
Locations:
city: Albi
country: France
facility: CH d'Albi
city: Auch
country: France
facility: CH d'Auch
city: Cahors
country: France
facility: CH de Cahors
city: Castres
country: France
facility: CHI Castres Mazamet
city: Foix
country: France
facility: CH Ariège Couserans
city: Gourdon
country: France
facility: CH de Gourdon
city: Lannemezan
country: France
facility: CH Lannemezan
city: Lavaur
country: France
facility: CH Lavaur
city: Lourdes
country: France
facility: CH de Lourdes
city: Moissac
country: France
facility: CH Castelsarrasin Moissac
city: Montauban
country: France
facility: CH Montauban
city: Rodez
country: France
facility: CH Rodez
city: Saint Gaudens
country: France
facility: CH Saint Gaudens
city: Saint Girons
country: France
facility: CHI Val d'Ariège
city: Toulouse
country: France
facility: Toulouse University Hospital (CHU de Toulouse)
city: Vic en Bigorre
country: France
facility: CH de Bigorre
Study officials:
affiliation: University Hospital, Toulouse
name: Yves ROLLAND, MD PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Perrin A, Tavassoli N, Mathieu C, Hermabessiere S, Houles M, McCambridge C, Magre E, Fernandez S, Caquelard A, Charpentier S, Lauque D, Azema O, Bismuth S, Chicoulaa B, Oustric S, Costa N, Molinier L, Vellas B, Berard E, Rolland Y. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol. Contemp Clin Trials Commun. 2017 Jul 21;7:217-223. doi: 10.1016/j.conctc.2017.07.005. eCollection 2017 Sep.
citation: Rolland Y, Mathieu C, Tavassoli N, Berard E, Laffon de Mazieres C, Hermabessiere S, Houles M, Perrin A, Krams T, Qassemi S, Cambon A, Magre E, Cantet C, Charpentier S, Lauque D, Azema O, Chicoulaa B, Oustric S, McCambridge C, Gombault-Datzenko E, Molinier L, Costa N, De Souto Barreto P. Factors Associated with Potentially Inappropriate Transfer to the Emergency Department among Nursing Home Residents. J Am Med Dir Assoc. 2021 Dec;22(12):2579-2586.e7. doi: 10.1016/j.jamda.2021.04.002. Epub 2021 May 5.
citation: Bouzid W, Cantet C, Berard E, Mathieu C, Hermabessiere S, Houles M, Krams T, Qassemi S, Cambon A, McCambridge C, Tavassoli N, Rolland Y. Exploring Predictive Factors for Potentially Avoidable Emergency Department Transfers: Findings From the FINE Study. J Am Med Dir Assoc. 2024 Apr;25(4):572-579.e1. doi: 10.1016/j.jamda.2023.11.017. Epub 2023 Dec 27.
citation: Dubucs X, Balen F, Charpentier S, Lauque D, De Souto Barreto P, Tavassoli N, Houze-Cerfon CH, Rolland Y. Factors associated with Emergency Medical Dispatcher request and residents' inappropriate transfers from Nursing Homes to Emergency Department. Eur Geriatr Med. 2022 Apr;13(2):351-357. doi: 10.1007/s41999-021-00574-5. Epub 2021 Oct 15.