Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial
Abstract Background Improved discharge arrangements and targeted post-discharge follow-up can reduce the risk of adverse events after hospital discharge for elderly patients. Although more care is to shift from specialist to primary care, there are few studies on post-discharge interventions run by...
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-017-2206-3 |
| _version_ | 1819095864020303872 |
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| author | Tove Røsstad Øyvind Salvesen Aslak Steinsbekk Anders Grimsmo Olav Sletvold Helge Garåsen |
| author_facet | Tove Røsstad Øyvind Salvesen Aslak Steinsbekk Anders Grimsmo Olav Sletvold Helge Garåsen |
| author_sort | Tove Røsstad |
| collection | DOAJ |
| description | Abstract Background Improved discharge arrangements and targeted post-discharge follow-up can reduce the risk of adverse events after hospital discharge for elderly patients. Although more care is to shift from specialist to primary care, there are few studies on post-discharge interventions run by primary care. A generic care pathway, Patient Trajectory for Home-dwelling elders (PaTH) including discharge arrangements and follow-up by primary care, was developed and introduced in Central Norway Region in 2009, applying checklists at defined stages in the patient trajectory. In a previous paper, we found that PaTH had potential of improving follow-up in primary care. The aim of this study was to establish the effect of PaTH—compared to usual care—for elderly in need of home care services after discharge from hospital. Methods We did an unblinded, cluster randomised controlled trial with 12 home care clusters. Outcomes were measured at the patient level during a 12-month follow-up period for the individual patient and analysed applying linear and logistic mixed models. Primary outcomes were readmissions within 30 days and functional level assessed by Nottingham extended ADL scale. Secondary outcomes were number and length of inpatient hospital care and nursing home care, days at home, consultations with the general practitioners (GPs), mortality and health related quality of life (SF-36). Results One-hundred and sixty-three patients were included in the PaTH group (six clusters), and 141 patients received care as usual (six clusters). We found no statistically significant differences between the groups for primary and secondary outcomes except for more consultations with the GPs in PaTH group (p = 0.04). Adherence to the intervention was insufficient as only 36% of the patients in the intervention group were assessed by at least three of the four main checklists in PaTH, but this improved over time. Conclusions Lack of adherence to PaTH rendered the study inconclusive regarding the elderly’s functional level, number of readmissions after hospital discharge, and health care utilisation except for more consultations with the GPs. A targeted exploration of prerequisites for implementation is recommended in the pre-trial phase of complex intervention studies. Trial registration Clinical Trials.gov NCT01107119 , retrospectively registered 2010.04.18. |
| first_indexed | 2024-12-21T23:50:04Z |
| format | Article |
| id | doaj.art-6c095d3408764903a06f1f1aaaf12269 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T23:50:04Z |
| publishDate | 2017-04-01 |
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| series | BMC Health Services Research |
| spelling | doaj.art-6c095d3408764903a06f1f1aaaf122692022-12-21T18:45:57ZengBMCBMC Health Services Research1472-69632017-04-011711910.1186/s12913-017-2206-3Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trialTove Røsstad0Øyvind Salvesen1Aslak Steinsbekk2Anders Grimsmo3Olav Sletvold4Helge Garåsen5Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU)Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU)Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU)Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU)Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU)Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU)Abstract Background Improved discharge arrangements and targeted post-discharge follow-up can reduce the risk of adverse events after hospital discharge for elderly patients. Although more care is to shift from specialist to primary care, there are few studies on post-discharge interventions run by primary care. A generic care pathway, Patient Trajectory for Home-dwelling elders (PaTH) including discharge arrangements and follow-up by primary care, was developed and introduced in Central Norway Region in 2009, applying checklists at defined stages in the patient trajectory. In a previous paper, we found that PaTH had potential of improving follow-up in primary care. The aim of this study was to establish the effect of PaTH—compared to usual care—for elderly in need of home care services after discharge from hospital. Methods We did an unblinded, cluster randomised controlled trial with 12 home care clusters. Outcomes were measured at the patient level during a 12-month follow-up period for the individual patient and analysed applying linear and logistic mixed models. Primary outcomes were readmissions within 30 days and functional level assessed by Nottingham extended ADL scale. Secondary outcomes were number and length of inpatient hospital care and nursing home care, days at home, consultations with the general practitioners (GPs), mortality and health related quality of life (SF-36). Results One-hundred and sixty-three patients were included in the PaTH group (six clusters), and 141 patients received care as usual (six clusters). We found no statistically significant differences between the groups for primary and secondary outcomes except for more consultations with the GPs in PaTH group (p = 0.04). Adherence to the intervention was insufficient as only 36% of the patients in the intervention group were assessed by at least three of the four main checklists in PaTH, but this improved over time. Conclusions Lack of adherence to PaTH rendered the study inconclusive regarding the elderly’s functional level, number of readmissions after hospital discharge, and health care utilisation except for more consultations with the GPs. A targeted exploration of prerequisites for implementation is recommended in the pre-trial phase of complex intervention studies. Trial registration Clinical Trials.gov NCT01107119 , retrospectively registered 2010.04.18.http://link.springer.com/article/10.1186/s12913-017-2206-3Health service researchControlled randomised trialComplex interventionCare pathwayContinuity of careCare coordination |
| spellingShingle | Tove Røsstad Øyvind Salvesen Aslak Steinsbekk Anders Grimsmo Olav Sletvold Helge Garåsen Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial BMC Health Services Research Health service research Controlled randomised trial Complex intervention Care pathway Continuity of care Care coordination |
| title | Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial |
| title_full | Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial |
| title_fullStr | Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial |
| title_full_unstemmed | Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial |
| title_short | Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial |
| title_sort | generic care pathway for elderly patients in need of home care services after discharge from hospital a cluster randomised controlled trial |
| topic | Health service research Controlled randomised trial Complex intervention Care pathway Continuity of care Care coordination |
| url | http://link.springer.com/article/10.1186/s12913-017-2206-3 |
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