Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study
Introduction Older adults with an acute moderate-to-severe lower respiratory tract infection (LRTI) or pneumonia are generally treated in hospitals causing risk of iatrogenic harm such as functional decline and delirium. These hospitalisations are often a consequence of poor collaboration between re...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/8/e073126.full |
| _version_ | 1797740705455538176 |
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| author | Mattijs E Numans Jojanneke Kant Rimke C Vos Cees van Nieuwkoop Frederiek van den Bos Rick Roos Rianne M C Pepping Maarten O van Aken Geert Labots Ali Lahdidioui Johanna M W van den Berg Nikki E Kolfschoten Sharif M Pasha Joris T ten Holder Susan M Mollink Ingrid Kroon |
| author_facet | Mattijs E Numans Jojanneke Kant Rimke C Vos Cees van Nieuwkoop Frederiek van den Bos Rick Roos Rianne M C Pepping Maarten O van Aken Geert Labots Ali Lahdidioui Johanna M W van den Berg Nikki E Kolfschoten Sharif M Pasha Joris T ten Holder Susan M Mollink Ingrid Kroon |
| author_sort | Mattijs E Numans |
| collection | DOAJ |
| description | Introduction Older adults with an acute moderate-to-severe lower respiratory tract infection (LRTI) or pneumonia are generally treated in hospitals causing risk of iatrogenic harm such as functional decline and delirium. These hospitalisations are often a consequence of poor collaboration between regional care partners, the lack of (acute) diagnostic and treatment possibilities in primary care, and the presence of financial barriers. We will evaluate the implementation of an integrated regional care pathway (‘The Hague RTI Care Bridge’) developed with the aim to treat and coordinate care for these patients outside the hospital.Methods and analysis This is a prospective mixed methods study. Participants will be older adults (age≥65 years) with an acute moderate-to-severe LRTI or pneumonia treated outside the hospital (care pathway group) versus those treated in the hospital (control group). In addition, patients, their informal caregivers and treating physicians will be asked about their experiences with the care pathway. The primary outcome of this study will be the feasibility of the care pathway, which is defined as the percentage of patients treated outside the hospital, according to the care pathway, whom fully complete their treatment without the need for hospitalisation within 30 days of follow-up. Secondary outcomes include the safety of the care pathway (30-day mortality and occurrence of complications (readmissions, delirium, falls) within 30 days); the satisfaction, usability and acceptance of the care pathway; the total number of days of bedridden status or hospitalisation; sleep quantity and quality; functional outcomes and quality of life.Ethics and dissemination The Medical Research Ethics Committee Leiden The Hague Delft (reference number N22.078) has confirmed that the Medical Research Involving Human Subjects Act does not apply to this study. The results will be published in international peer-reviewed journals.Trial registration number ISRCTN68786381. |
| first_indexed | 2024-03-12T14:16:14Z |
| format | Article |
| id | doaj.art-2ddfa850e9a94c84bbbb56ca6c3c56b4 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-12T14:16:14Z |
| publishDate | 2023-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-2ddfa850e9a94c84bbbb56ca6c3c56b42023-08-20T09:20:07ZengBMJ Publishing GroupBMJ Open2044-60552023-08-0113810.1136/bmjopen-2023-073126Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods studyMattijs E Numans0Jojanneke Kant1Rimke C Vos2Cees van Nieuwkoop3Frederiek van den Bos4Rick Roos5Rianne M C Pepping6Maarten O van Aken7Geert Labots8Ali Lahdidioui9Johanna M W van den Berg10Nikki E Kolfschoten11Sharif M Pasha12Joris T ten Holder13Susan M Mollink14Ingrid Kroon15Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The NetherlandsHadoks, The Hague, The NetherlandsDepartment of Public Health and Primary Care, LUMC, Leiden, the NetherlandsDepartment of Internal Medicine, Haga Teaching Hospital, The Hague, The NetherlandsDepartment of Internal Medicine, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Internal Medicine, Haga Teaching Hospital, The Hague, The NetherlandsHealth Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The NetherlandsDepartment of Internal Medicine, Haga Teaching Hospital, The Hague, The NetherlandsDepartment of Internal Medicine, Haga Teaching Hospital, The Hague, The NetherlandsDepartment of Internal Medicine, Haga Teaching Hospital, The Hague, The NetherlandsDepartment of Pulmonology, Haga Teaching Hospital, The Hague, The NetherlandsDepartment of Emergency Medicine, Haga Teaching Hospital, The Hague, The NetherlandsDepartment of Internal Medicine, Haaglanden Medical Center, The Hague, The NetherlandsDepartment of Pulmonology, Haaglanden Medical Center, The Hague, The NetherlandsDepartment of Emergency Medicine, Haaglanden Medical Center, The Hague, The NetherlandsKroon Elderly Care Physician, The Hague, The NetherlandsIntroduction Older adults with an acute moderate-to-severe lower respiratory tract infection (LRTI) or pneumonia are generally treated in hospitals causing risk of iatrogenic harm such as functional decline and delirium. These hospitalisations are often a consequence of poor collaboration between regional care partners, the lack of (acute) diagnostic and treatment possibilities in primary care, and the presence of financial barriers. We will evaluate the implementation of an integrated regional care pathway (‘The Hague RTI Care Bridge’) developed with the aim to treat and coordinate care for these patients outside the hospital.Methods and analysis This is a prospective mixed methods study. Participants will be older adults (age≥65 years) with an acute moderate-to-severe LRTI or pneumonia treated outside the hospital (care pathway group) versus those treated in the hospital (control group). In addition, patients, their informal caregivers and treating physicians will be asked about their experiences with the care pathway. The primary outcome of this study will be the feasibility of the care pathway, which is defined as the percentage of patients treated outside the hospital, according to the care pathway, whom fully complete their treatment without the need for hospitalisation within 30 days of follow-up. Secondary outcomes include the safety of the care pathway (30-day mortality and occurrence of complications (readmissions, delirium, falls) within 30 days); the satisfaction, usability and acceptance of the care pathway; the total number of days of bedridden status or hospitalisation; sleep quantity and quality; functional outcomes and quality of life.Ethics and dissemination The Medical Research Ethics Committee Leiden The Hague Delft (reference number N22.078) has confirmed that the Medical Research Involving Human Subjects Act does not apply to this study. The results will be published in international peer-reviewed journals.Trial registration number ISRCTN68786381.https://bmjopen.bmj.com/content/13/8/e073126.full |
| spellingShingle | Mattijs E Numans Jojanneke Kant Rimke C Vos Cees van Nieuwkoop Frederiek van den Bos Rick Roos Rianne M C Pepping Maarten O van Aken Geert Labots Ali Lahdidioui Johanna M W van den Berg Nikki E Kolfschoten Sharif M Pasha Joris T ten Holder Susan M Mollink Ingrid Kroon Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study BMJ Open |
| title | Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study |
| title_full | Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study |
| title_fullStr | Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study |
| title_full_unstemmed | Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study |
| title_short | Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study |
| title_sort | evaluation of an integrated care pathway for out of hospital treatment of older adults with an acute moderate to severe lower respiratory tract infection or pneumonia protocol of a mixed methods study |
| url | https://bmjopen.bmj.com/content/13/8/e073126.full |
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