Clinical trial NCT03486977: Effectiveness and Organizational Conditions of Effectiveness of Telemedicine in Establishments Providing Care for the Dependent Elderly
Official title: Effectiveness and Organizational Conditions of Effectiveness of Telemedicine in Establishments Providing Care for the Dependent Elderly
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Health Services for the Aged
Lead sponsor: University Hospital, Bordeaux
Sponsor class: OTHER
First posted: 2018-04-03
Enrollment: 373
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: All residents of EHPAD, men and women 65 years of age and more and likely to be eligible for a teleconsultation as suffering from one of the identified chronic pathologies as a reason for teleconsultation by Regional Agency of Hearth, will be included in the study in two groups of long-term care facilities. Eligible residents will be included in a very short time of 3 months.

Brief summary: Study of interest of Telemedicine in establishments providing care for the dependent elderly (EHPAD in french) is a strategy for improving the course of care of residents, including the number not programmed hospitalizations, and a multidimensional analysis of the conditions of effectiveness of telemedicine will identify the keys to optimize its use.

Detailed description: The project combines quantitative and qualitative analyses :

1. Quantitative study

Study of comparative prospective cohort clustered in two parallel groups:

Group 'Telemedicine': establishments providing care for the dependent elderly (EHPAD in french) equipped for telemedicine (teleconsultation, casualty) as part of the regional project of the Aquitaine Regional Agency of Heath telemedicine device deployment.

Control group: Defined and equipped for telemedicine EHPAD after matching on the number of residents, the GMP (average weighted GIR : "Groupes Iso Ressources" = score to reflects the average level of dependency of residents of a residential care facility for the elderly), the PMP (weighted average PATHOS = an evaluation system set up by the National Union of Clinical Gerontology and the Medical Service of the National Fund for Health Insurance for Salaried Workers), the distance to a hospital with an emergency shelter service.

The rate of unscheduled hospitalizations will be collected during follow-up visits in clinical departments of the healthcare of the Gironde (french department) by a research staff.

2 Qualitative study In the Group of nursing homes with telemedicine, said group "Telemedicine", will be identified four long-term care facilities, selected according to their degree of use of telemedicine (ratio number of teleconsultation per month / number of beds) (EHPAD 2 strong users, 2 nursing homes) low users) within these four long-term care facilities will be carried out observations of field and in-depth interviews with professionals, managers and attending physicians.

Eligibility criteria: Inclusion Criteria:

Quantitative research:

* All residents of nursing home men and women 65 years of age and more and likely to be eligible for a teleconsultation or a casualty because achieved one of the identified chronic pathologies as a reason for teleconsultation, will be included in both groups of long-term care
* Medical professionals working in the nursing home agreeing to answer the specifics questionnaires

Qualitative study:

* Doctors, physicians and coordinators nurses of Establishments Providing Care for the Dependent Elderly, nurses, orderly, psychologists, directors of Establishments
* Having a professional activity in nursing homes selected
* Having given their consent to participate in the study

Exclusion Criteria:

* Residents of long-term care facilities (quantitative study) Resident (or guardian/person) who expressed his opposition to participate in the study or not likely to be eligible for a teleconsultation or casualty Establishments Providing Care for the Dependent Elderly (qualitative) professionals
* Professional who expressed his opposition to participate in the study

Primary outcomes:
measure: Number of hospitalization not programmed residents on Medicine Surgery obstetrics (MCO)
timeFrame: 12 months
Secondary outcomes:
measure: the main diagnosis, coded by the International Classification of diseases for every hospitalization
timeFrame: 12 months
measure: Score of the specific questionnaire for measurement of the context organizational and Managerial in health care facilities
timeFrame: 12 months
Other outcomes:
Locations:
city: Pessac
country: France
facility: EHPAD CHU Bordeaux
state: Lormont
city: Arsac
country: France
facility: EHPAD Le home medocain Arsac
city: Bordeaux
country: France
facility: EHPAD Henry Dunant
city: Bordeaux
country: France
facility: EHPAD Le Clos Serena
city: Bordeaux
country: France
facility: EHPAD Résidence les Carmes
city: Bordeaux
country: France
facility: EHPAD Cos villa Pia
city: Bordeaux
country: France
facility: EHPAD Grand Bon Pasteur
city: Bordeaux
country: France
facility: EHPAD Residence Aime Cesaire
city: Bordeaux
country: France
facility: EHPAD Le Platane du Grand Parc
city: Bègles
country: France
facility: EHPAD Le parc du Bequet
city: Bègles
country: France
facility: EHPAD Manon Cormier
city: Cestas
country: France
facility: EHPAD Seguin
city: Fronsac
country: France
facility: EHPAD résidence du Tertre
city: Gradignan
country: France
facility: EHPAD Douceur de France
city: Gujan-Mestras
country: France
facility: EHPAD Résidence l'Arousiney
city: Lamarque
country: France
facility: EHPAD Le rétou
city: Lormont
country: France
facility: EHPAD Les coteaux
city: Mérignac
country: France
facility: Résidence de Médicis
city: Pessac
country: France
facility: EHPAD Fontaudin
city: Rauzan
country: France
facility: EHPAD Villa presentine
city: Saint Seurin sur l'Isle
country: France
facility: EHPAD Jacqueline Auriol
city: Talence
country: France
facility: EHPAD Résidence La berge du lac
city: Talence
country: France
facility: EHPAD Villa Bontemps
city: Villenave-d'Ornon
country: France
facility: EHPAD Home Marie Curie
Study officials:
affiliation: University Hospital, Bordeaux
name: Nathalie SALLES, MD, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: University Hospital, Bordeaux
name: Florence SALLIOUR, PhD
role: STUDY_CHAIR
References:
citation: Han JH, Morandi A, Ely EW, Callison C, Zhou C, Storrow AB, Dittus RS, Habermann R, Schnelle J. Delirium in the nursing home patients seen in the emergency department. J Am Geriatr Soc. 2009 May;57(5):889-94. doi: 10.1111/j.1532-5415.2009.02219.x.
citation: Morandi A, Han JH, Callison C, Ely EW, Schnelle JF. Delirium in nursing home residents across care transitions: a preliminary report. J Am Geriatr Soc. 2009 Oct;57(10):1956-8. doi: 10.1111/j.1532-5415.2009.02472.x. No abstract available.
citation: Vellas B. Integrating Frailty into Clinical Practice to Prevent the Risk of Dependency in the Elderly. Nestle Nutr Inst Workshop Ser. 2015;83:99-104. doi: 10.1159/000382092. Epub 2015 Oct 20.
citation: Graverholt B, Forsetlund L, Jamtvedt G. Reducing hospital admissions from nursing homes: a systematic review. BMC Health Serv Res. 2014 Jan 24;14:36. doi: 10.1186/1472-6963-14-36.
citation: Salles N, Saillour-Glenisson F, Sibe M, Langlois E, Kret M, Durrieu J, Arditi N, Abraham M, Perry F. Effectiveness and organizational conditions of effectiveness of telemedicine in nursing homes. A study protocol of a comparative prospective cohort (EFFORT study). Digit Health. 2021 Jan 24;7:2055207620982422. doi: 10.1177/2055207620982422. eCollection 2021 Jan-Dec.