Hospital at Home for Elderly Acute Ill Patients
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age65+
SponsorDefactum, Central Denmark Region
About this trial
Many elderly patients with uncomplicated treatment courses are admitted unnecessarily, which is a burden for the patient and society. Studies show that Hospital at Home (HaH) treatment is an alternative to hospitalization. The patient's risk of delirium, infection and loss of function is reduced when the patient avoids the hospital stay. HaH treatment is expected to be more cost-effective, improve patients' functional abilities and patients' satisfaction.
Three municipalities, general practitioners, pre-hospital service and an emergency department (ED) in Central Denmark Region have organized the first HaH treatment model across disciplines and sectors. Specialists in the ED and the municipal acute teams provide HaH treatment for elderly acute ill patients. However, the model has not yet been evaluated.
The aim of this study is to optimize the HaH treatment model for elderly acute ill patients. The objective is to increase patient satisfaction and optimize the use of resources in healthcare by avoiding unnecessary hospitalizations that impair and prolong treatment.
This study is an open label randomized controlled trial (RCT) with a 1:2 allocation ratio of acute hospital admission versus HaH. During a pilot period, we tested and adapted the patient pathway of HaH to the practical reality, before we start the randomization for the RCT study. We will investigate the clinical effects and health economic consequences of HaH treatment compared with standard hospital treatment.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
The patient should be aged 65 and over
Diagnosed with a stable acute medical conditions e.g. cystitis, erysipelas, pneumonia
The patient should be living in their own home or a nursing home before entering the study
The patient should be residing in one of the three municipalities (Viborg, Skive and Silkeborg)
Disqualifiers
The patient is unable to give written consent
The capacity of the municipal acut team care was fully utilised.
Trial design
Design model
Parallel
Treatments tested in this trial
Hospital at Home (HaH) treatment
Other interventionThe intervention is a new pathway of providing acut treatment for elderly acute ill patients in their own home. If the patient is randomized to the intervention group, the municipalities acute teams start the treatment. The acute team can take venous blood tests, ECG and bladder scan at home. The acute team handles the treatment at home and follows the patient closely. During the treatment course, the acute team and the ED specialist discuss the treatment process either over the phone or virtually on an iPad, where the patient is also involved. If the specialist would like to see the patient for assessment or send the patient for an X-ray, the specialist informs the acute team that the patient must go to a short check-up in the ED. Here, the specialist examines the patient himself and assesses whether the patient can continue to be treated at home, or whether the patient must be admitted to the hospital due to deterioration of the condition.
Standard hospital admission
Other interventionThe active comparator is the standard hospital admission for elderly acute ill patients.
Treatment groups
849 Participants
are divided into 2 treatment groupsGroup A: Hospital at Home (HaH) treatmentExperimental treatment 1 intervention
Group B: Standard hospital admissionActive comparator 1 intervention
Trial outcomes
Primary outcomes
1
Rate of 30-days re-admission
Rate of 30-days re-admission after discharge
Time frame
30 days period after discharge2
Health Related Quality of Life
Estimating quality of life by using EuroQoL-5 Dimensions. We will use EuroQoL-5 Dimensions to measure Health Related Quality of Life. The five dimensions include mobility, self-care, usual activity, pain/discomfort and anexiety/depression.This tool will provide us with health states (11111 being the best health state and 55555 the worse health state). We will use the Danish weight to give weights to different health states obtained from EuroQoL-5 Dimensions.
Time frame
From inclusion to 3 months follow-upSecondary outcomes
1
Functional mobility test
Estimating basic functional mobility by using Timed Up and Go (TUG)
Time frame
From inclusion to 3 months follow-up2
Mortality rate
Estimating mortality rate for the study population using the National Registries
Time frame
From inclusion to 3 months follow-up3
Number of contacts to primary and secondary health care system
The Danish National Registries will be used to estimate number of contacts to the primary and secondary healthcare for both control and intervention groups.
Time frame
From inclusion to 3 months follow-upSponsors and contacts
Click on the lead sponsor to view all of their trials.
Defactum, Central Denmark Region
Lead sponsor
Interdisciplinary Centre for Organizational Architecture (ICOA), Aarhus University, Denmark
Collaborator
Research Center for Emergency Medicine, Aarhus University, Denmark
Collaborator
Viborg Regional Hospital
Collaborator
Source ClinicalTrials.gov