Effects of a new early municipality-based versus a geriatric team-based transitional care intervention on readmission and mortality among frail older patients – a randomised controlled trial

Hansen, Troels Kjærskov; Pedersen, Lene Holst; Shahla, Seham; Damsgaard, Else Marie; Bruun, Jens Meldgaard; Gregersen, Merete

doi:10.1016/j.archger.2021.104511

Cited by 11 publications

(9 citation statements)

References 41 publications

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“…Hence the 90-day mortality rate for the standard care group was set to 32%. The assumed effect of the intervention was calculated on the basis of the 12% 90-day mortality rate among CDI patients receiving FMT (55) and the 20% mortality rate in geriatric patients receiving CGA (29). However, in Hocquart' s study (55) a sixth of the patients are below the age of 70 years and therefore, the 12% mortality rate might be underestimated.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…However, in Hocquart' s study (55) a sixth of the patients are below the age of 70 years and therefore, the 12% mortality rate might be underestimated. Furthermore, Hansen et al (29) only performed CGA on moderate to severely frail patients. As we will include patients also with mild frailty, the 90-day mortality rate of 20% might be overestimated.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…This was documented in the setting of in-hospital medical patients in dedicated ageing and health wards and across different departments and medical conditions (25,26). In a Danish older adult inpatient population, an early geriatric follow-up conducted by outgoing geriatric teams after discharge reduced readmission rates (27)(28)(29) and mortality rates in such patients living in their own homes (30).…”

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confidence: 99%

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Clostridioides difficile infection in frail older patients, quality in treatment and care: the CLODIFRAIL study protocol for a multicentre randomised controlled trial

Rubak

Veilbæk

Gregersen

et al. 2023

Preprint

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Background: Clostridioides difficile infection (CDI) is complex and associated with adverse clinical outcomes in older patients, including increased mortality rates. Effective transition of care for patients with CDI is critical to improve survival and health outcomes and to reduce recurrence rates. The aim of this study is to investigate the effects of a geriatric tailored intervention for older patients with CDI on patient survival, compared with older patients with CDI who receive usual care. Methods: This is a quality improvement study, comparing two organisational pathways. We include 216 patients aged 70 years or more and diagnosed with CDI. Patients with a positive Clostridioides difficiletoxin PCR test are randomised 1:1 to either 1) a geriatric tailored assessment and intervention (the CLODIFRAIL intervention) or 2) usual care at the treating physician’s discretion. The intervention consists of three main parts: 1) a clinical geriatric assessment; 2) a clinical evaluation of indication for and treatment with faecal microbiota transplantation (FMT); 3) weekly clinical assessments during eight weeks. The follow-up period is 90 days. The primary outcome is 90-day survival from the date of positive CDI PCR test. Patient-related secondary outcome measures include quality of life measured by EQ-5D-5L and by the Overall Quality of Life Depression List (OQoL-DL) and functional status measured by the Functional Recovery Score (FRS). Quality-related secondary outcome measures include time-to-treatment with FMT, time-to-treatment with vancomycin, CDI recurrence, readmission, and days in hospital. Discussion: This study will provide new knowledge on the effects of a geriatric tailored intervention for older patients with CDI, including an early assessment of the indication for FMT. Trial registration: The study was pre-registered at ClinicalTrials.gov on 28 June, 2022. Study identifier: NCT05447533.

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Section: Sample Size Calculationmentioning

confidence: 99%

Section: Sample Size Calculationmentioning

confidence: 99%

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confidence: 99%

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Clostridioides difficile infection in frail older patients, quality in treatment and care: the CLODIFRAIL study protocol for a multicentre randomised controlled trial

Rubak

Veilbæk

Gregersen

et al. 2023

Preprint

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“…Effects were inspected from the patient perspective [ 7 , 15 , 17 ]. Researchers emphasized family members’ need for TC, but most studies did not assess their perspectives on the effectiveness of TC [ 16 , 18 ]. Although the population of Asia is aging among the fastest globally [ 19 ], the capacity to research TC in Asia is far less than in Europe and America [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Improving transitional care through online communication skills training

et al. 2022

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Background As the aging population is increasing significantly, the communication skills training (CST) on transitional care (TC) is insufficient. Aims This study aimed to test the effectiveness of an intervention (the online TC CST [OTCCST] and TC) through the perspectives of healthcare providers (HCPs), older patients, and family members. Methods A total of 38 HCPs caring for older patients were randomized to the experimental ( n = 18) or control groups ( n = 20), and 84 pairs of patients and family members were enrolled (experimental: n = 42 vs. control: n = 42). The primary outcome was HCP communication confidence; while secondary outcomes included patient quality of life (QoL), activities of daily living (ADL), rehospitalization counts, and family caregiving burden. Data were collected from HCPs using a scale measuring confidence in communicating with patients. Patient outcomes were assessed using the McGill QoL Questionnaire-Revised and Barthel Index. Family members were assessed with the Caregiver Burden Inventory. Rehospitalization counts were tracked for 3 months post-discharge. Data were analyzed using multiple regression analysis. Results Experimental group HCPs showed a significant improvement in communication confidence over the control group ( p = 0.0006). Furthermore, experimental group patients had significantly fewer rehospitalization counts within 3-month post-discharge ( p < 0.05). However, no significant group differences were found in patient QoL and ADL nor in family caregiver burden. Conclusion The OTCCST can effectively improve HCP communication confidence, and the combination of OTCCST and TC can reduce rehospitalization counts for older patients. The OTCCST allows HCPs to learn asynchronously at their convenience, ideal for continuing education, especially during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02251-4.

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“…The effects of TCIs on readmission rates vary. However, most studies have reported positive findings [ 16 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of a transitional care intervention on readmission among older medical inpatients: a quasi-experimental study

Rasmussen

Barat

Riis³

et al. 2022

Eur Geriatr Med

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Purpose To evaluate the effect of a transitional care intervention (TCI) on readmission among older medical inpatients. Methods This non-randomised quasi-experimental study was conducted at Horsens Regional Hospital in Denmark from 1 February 2017 to 31 December 2018. Inclusion criteria were patients ≥ 75 years old admitted for at least 48 h. First, patients were screened for eligibility. Then, the allocation to the intervention or control group was performed according to the municipality of residence. Patients living in three municipalities were offered the hospital-based intervention, and patients living in a fourth municipality were allocated to the control group. The intervention components were (1) discharge transportation with a home visit, (2) a post-discharge cross-sectorial video conference and (3) seven-day telephone consultation. The primary outcome was 30-day unplanned readmission. Secondary outcomes were 30- and 90-day mortality and days alive and out of hospital (DAOH). Results The study included 1205 patients (intervention: n = 615; usual care: n = 590). In the intervention group, the median age was 84.3 years and 53.7% were females. In the control group, the median age was 84.9 years and 57.5% were females. The 30-day readmission rates were 20.8% in the intervention group and 20.2% in the control group. Adjusted relative risk was 1.00 (95% confidence interval: 0.80, 1.26; p = 0.99). No significant difference was found between the groups for the secondary outcomes. Conclusion The TCI did not impact readmission, mortality or DAOH. Future research should conduct a pilot test, address intervention fidelity and consider real-world challenges. Trial registration Clinical trial number: NCT04796701. Registration date: 24 February 2021.

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Effects of a new early municipality-based versus a geriatric team-based transitional care intervention on readmission and mortality among frail older patients – a randomised controlled trial

Cited by 11 publications

References 41 publications

Clostridioides difficile infection in frail older patients, quality in treatment and care: the CLODIFRAIL study protocol for a multicentre randomised controlled trial

Clostridioides difficile infection in frail older patients, quality in treatment and care: the CLODIFRAIL study protocol for a multicentre randomised controlled trial

Improving transitional care through online communication skills training

Effects of a transitional care intervention on readmission among older medical inpatients: a quasi-experimental study

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