Validation of an integrated service model, Health-RESPECT, for older patients in long-term care institution using information and communication technologies: protocol of a cluster randomised controlled trial

Abstract

IntroductionThere is an increased healthcare need to manage institutionalised older patients owing to the ageing population. To overcome substantial future challenges, the Health-RESPECT (caRE Systems for Patients/Elderly with Coordinated care using icT), a new information and communication technologies based integrated management service model, was developed to provide effective management, enable consultation with distant professionals and share medical information between acute care hospitals and long-term care institutions.Methods and analysisA cluster randomised controlled trial will be conducted to examine the effectiveness of the Health-RESPECT in older patients with chronic diseases and their medical staff in charge. Intervention involves registration with simple comprehensive geriatric assessment, establishment of an individualised care plan for three chronic diseases (hypertension, diabetes and heart failure), medication and rehabilitation management, periodic video-conference and in-system assessment after intervention period. Primary outcomes are control levels of the three chronic diseases, adequacy of drug management and overall functional status. Patients will be assessed at before and after study period and 3 months after study ended. Analysis will be carried out with an intention-to-treat principle. In addition to evaluate intervention effects, clinical usability and economic evaluation will be assessed.Ethics and disseminationThe study protocol was reviewed and approved by the Seoul National University Bundang Hospital Institutional Review Board. Study findings will be published in peer-reviewed journals.Trial registration numberKCT0004360.

Factors associated with anticholinergic burden among older patients in long-term care hospitals in Korea

“…The medical staff in LTCHs also need an appropriate consultation system to facilitate the control of symptoms and to prevent disease aggravation without the need to transfer the patients to regional acute care hospitals. To solve these unmet needs for patients and medical staff in LTCHs, access to information on PIMs could be provided by linking the electronic medication record of the LTCH to the Health-RE-SPECT platform, along with periodic videoconferencing with the geriatrician of the regional acute care hospital, to ensure timely care of acute conditions [17]. In addition, linking the Health-RESPECT system to the health information exchange network system can ensure real-time monitoring and adjustment of PIMs and DAPs.…”

“…However, patients that were comatose, expected to expire, or to be discharged within 3 months were excluded. Specific inclusion and exclusion criteria and services provided were described previously [16,17]. We analysed the data of patients recruited from LTCHs only to maintain the homogeneity of the accuracy of the data because nursing homes do not use electronic medication record systems, and the prescriptions were received from multiple medical institutions.…”

Information technology-supported integrated health service for older adults in long-term care settings

“…We started recruiting participants in September 2019. The details of the Health-RESPECT study were published in a previous protocol paper [ 12 ]. The present study was registered with the Clinical Research Information Service (CRIS, https://cris.nih.go.kr/ , trial registration number: KCT0004360) (initial submission date: September 4, 2019).…”

“…The target blood pressure for hypertension was 140/90 mm Hg in the robust and prefrail groups and 150/90 mm Hg in the frail groups. The target hemoglobin A1c (HbA1c) for diabetes was < 7.5% in robust groups, < 8.0% in prefrail groups, and < 8.5% in frail groups, or for random glucose levels, the target was ≤ 190 mg/dL in robust groups, ≤ 210 mg/dL in prefrail groups and ≤ 230 mg/dL in frail groups [ 12 ]. Data on patients’ vital signs, laboratory findings, diagnosis, and prescribed medication were collected from the electronic medical records of the LTC institutions and accumulated in Health-RESPECT.…”

“…To overcome these challenges, we developed a new service model and system using an ICT called Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) [ 11 , 12 ]. The Health-RESPECT platform includes comprehensive geriatric assessment (CGA), a standardized management algorithm for chronic diseases, individualized rehabilitation protocol, medication screening and management, and consultation services with acute care hospitals.…”