Clinical trial NCT02421133: Impact of a Transitional Care Program on 30-Day Hospital Readmissions for Elderly Patients Discharged From a Short Stay Geriatric Ward
Official title: Impact of a Transitional Care Program Involving an Advanced Practice Nurse on 30-Day Hospital Readmissions for Elderly Patients Discharged From a Short Stay Geriatric Ward (PROUST Study)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Geriatrics
Keywords: Care transition program
Patient readmission
Transition Nurse
Stepped wedge
elderly
Lead sponsor: Hospices Civils de Lyon
Sponsor class: OTHER
First posted: 2015-04-20
Enrollment: 630
Sex: ALL
Minimum age (years): 75
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: In France, it has be estimated that the hospital readmission rate within 30 days of patients aged 75 or older is 14% (IC95% \[12.0-16.7\]), nearly a quarter being avoidable. There is evidence that interventions "bridging" the transition from hospital to home involving a dedicated professional (usually nurses) would be most effective in reducing the risk of readmission, but the level of evidence of current studies is low. Our study aims to assess the impact of a program of transitional care from hospital to home for people of 75 years old or more admitted to acute care.

Detailed description: The study is a stepped wedge randomized cluster study. Intervention: The transition care program, involving a dedicated advanced practice nurse, will include: 1) during the patient's stay in hospital: an individualized needs-based comprehensive discharge plan and a transitional care record ; the notification of the primary care physician about inpatient care and hospital discharge; 2) the day of the discharge: specific explanations about the organization of home care provided by the transition care nurse to the patient; 3) during 4 weeks after discharge: monitoring patients and caregivers regularly through home visits and/or telephone contact,

Eligibility criteria: Inclusion Criteria:

* Patient hospitalized for 48 hours or more in one of the acute geriatric service participating to the study.
* Aged 75 or older.
* Leaving at home and with home as the planned discharge after the admission.
* At risk of hospital readmission emergency visit rates after discharge (if he has two or more of the following criteria (taken from the Triage Risk Screening Tool and from the 2013 French recommendation)).

Exclusion Criteria:

* Patient leaving in a retirement home.
* Patient hospitalized at home.
* Patient leaving at home but at 30 km (18 miles) or more from the service of his index admission

Primary outcomes:
measure: 30-Day unscheduled hospital readmission or emergency visit rate after the index hospital discharge.
timeFrame: Within 30 days after hospital discharge.
Secondary outcomes:
measure: Length of stay in the short stay geriatric ward (index hospitalization)
timeFrame: Patients will be followed for the duration of hospital stay, an expected average between 2 days and 30 days
measure: Unscheduled hospital readmissions or emergency room visits
timeFrame: Within 30 and 90 days after the index hospital discharge.
measure: Free-hospitalization survival
timeFrame: Within 30 and 90 days after the index hospital discharge.
measure: Mortality rate
timeFrame: Within 30 and 90 days after the index hospital discharge.
measure: Adverse events (i.e. falls)
timeFrame: Within 30 days after the index hospital discharge.
measure: Quality of life.
timeFrame: Within 30 days after the index hospital discharge.
measure: Patients' satisfaction care transition programme
timeFrame: Within 30 days after the index hospital discharge.
measure: Delay between the index hospital discharge and the implementation of home care.
timeFrame: Within 30 days after the index hospital discharge.
measure: Number of contacts between the transition nurse and the primary care providers or the hospital providers after discharge
timeFrame: Within 30 days after the index hospital discharge.
measure: Costs of unscheduled hospital readmission or emergency visit
timeFrame: 30 days after discharge
Other outcomes:
Locations:
city: Albigny sur Saône
country: France
facility: CH Gériatrique des Monts d'Or
city: Bourg en Bresse
country: France
facility: CH Bourg-en-Bresse
city: Contamine sur Arve
country: France
facility: Centre Hospitalier Alpes Léman
city: Lyon
country: France
facility: Hôpital Édouard Herriot
city: Pierre Benite
country: France
facility: Centre Hospitalier Lyon Sud
city: Pringy
country: France
facility: CHG Annecy
city: Saint Chamond
country: France
facility: CH Saint-Chamond
city: Venissieux
country: France
facility: Clinique des portes du sud
city: Villefranche
country: France
facility: CH Villefranche
Study officials:
affiliation: Centre Hospitalier Lyon Sud-Hospices Civils de Lyon
name: Marc Bonnefoy
role: PRINCIPAL_INVESTIGATOR
References:
citation: Occelli P, Touzet S, Rabilloud M, Ganne C, Poupon Bourdy S, Galamand B, Debray M, Dartiguepeyrou A, Chuzeville M, Comte B, Turkie B, Tardy M, Luiggi JS, Jacquet-Francillon T, Gilbert T, Bonnefoy M. Impact of a transition nurse program on the prevention of thirty-day hospital readmissions of elderly patients discharged from short-stay units: study protocol of the PROUST stepped-wedge cluster randomised trial. BMC Geriatr. 2016 Mar 3;16:57. doi: 10.1186/s12877-016-0233-2.