Clinical trial NCT02949635: Patient Outcomes After Hospitalization in Acute Geriatric Unit
Official title: Risks of Death, Hospital Readmission, and Institutionalization After Hospitalization in Acute Geriatric Unit
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Geriatric Disorder
Keywords: Aged
Patient readmission
Geriatric Assessment
Mortality
Lead sponsor: University Hospital, Lille
Sponsor class: OTHER
Collaborators: name: Ministry of Health, France
First posted: 2016-10-31
Enrollment: 3532
Sex: ALL
Minimum age (years): 75
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All consecutive incident patients aged 75 years and older hospitalized in an acute geriatric unit will be eligible and included in the study.

Brief summary: Three events can be considered of major importance for patients after a hospitalization in an AGU: death, hospital readmission, and institutionalization. Current published data do not allow the clinician to simultaneously estimate the risk of hospital readmission, institutionalization and death of an older patient according to his/her characteristics and various complications that occurred during the hospitalization. However, clinicians often need to estimate these risks at hospital discharge to adapt their therapeutic choices, their proposals post-hospital care, and provide reliable and fair information to the patient and his relatives.

Estimating simultaneously the hazard for each of these three events can be complex. Indeed, a death event hinder the observation of re-hospitalization or institutionalization if death occurs before these events. The death should be considered a competing risk in these analyzes. Hospital readmission may modify the risk of death or institutionalization and should be considered as an intermediate factor for these event. This complexity cannot be accounted with classical statistical models, like logistic regression models.

The purpose of this study is to use more appropriate statistical models (multi-state models) to better estimate simultaneously the risks of hospital readmission, institutionalization, and death of a patient given after hospitalization in AGU, and to show that accuracy of these estimations can be improved by taking into account complications that occurred during the stay in AGU.


Eligibility criteria: Inclusion Criteria:

* Age 75 years and over
* Hospitalized in Acute Geriatric Unit
* Covered by a health insurance

Exclusion Criteria:

* Refusal to participate to the study, as expressed by the patient or his/her next of kin

Primary outcomes:
measure: Number of death after discharge
timeFrame: 3 months
Secondary outcomes:
measure: Number of death after discharge
timeFrame: 12 months
measure: Number of rehospitalization after discharge
timeFrame: at 3 and 12 months
measure: Number of institutionalization (NH admissions)
timeFrame: at 12 months
measure: Number of nosocomial infectious diseases during the index hospitalization
timeFrame: 60 days
measure: Duration of clostridium difficile infection
timeFrame: 60 days
measure: Length of stay of the index hospitalization
timeFrame: 60 days
Other outcomes:
Locations:
city: Amiens
country: France
facility: CHU d'Amiens
city: Beauvais
country: France
facility: CH Beauvais
city: Caen
country: France
facility: CHU Caen
city: Lille
country: France
facility: Hôpital Cardiologique, CHRU
city: Lomme
country: France
facility: GHICL, Saint Philibert
city: Saint quentin
country: France
facility: CH Saint Quentin
Study officials:
affiliation: University Hospital, Lille
name: Jean-Baptiste Beuscart, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Deschasse G, Charpentier A, Prod'homme C, Genin M, Delecluse C, Gaxatte C, Gerard C, Bukor Z, Devulder P, Couvreur LA, Bloch F, Puisieux F, Visade F, Beuscart JB. Transition to Comfort Care Only and End-of-Life Trajectories in an Acute Geriatric Unit: A Secondary Analysis of the DAMAGE Cohort. J Am Med Dir Assoc. 2022 Sep;23(9):1492-1498. doi: 10.1016/j.jamda.2022.04.016. Epub 2022 May 21.
citation: Deschasse G, Bloch F, Drumez E, Charpentier A, Visade F, Delecluse C, Loggia G, Lescure P, Attier-Zmudka J, Bloch J, Gaxatte C, Van Den Berghe W, Puisieux F, Beuscart JB. Development of a Predictive Score for Mortality at 3 and 12 Months After Discharge From an Acute Geriatric Unit as a Trigger for Advanced Care Planning. J Gerontol A Biol Sci Med Sci. 2022 Aug 12;77(8):1665-1672. doi: 10.1093/gerona/glab217.