ABSTRACT
INTRODUCTION: In Germany, an efficient and feasible transition from hospital to home for older patients, ensuring continuous care across healthcare settings, has not yet been applied and evaluated. Based on the transitional care model (TCM), this study aims to reduce preventable readmissions of patients ≥75 years of age with a transitional care intervention performed by geriatric-experienced care professionals. The study investigates whether the intervention ensures continuous care during transition and stabilises the care situation of patients at home. METHODS AND ANALYSES: Randomised controlled clinical trial, recruiting between 25 April 2018 and 31 December 2019 in one German hospital in the city of Regensburg. The intervention group is supported by care professionals in the transition process from hospital to home for up to 12 months. Based on TCM, the intervention includes an individual care plan according to a patient's symptoms, risks, needs and values. The plan is advanced in the domestic situation via personal visits and telephone contacts. All necessary care actions regarding, for example, mobility, residence adjustments, or nutrition, are initiated to be executed by ambulant care services, and are monitored, evaluated and adapted if necessary. In supervising the care plan, the care professionals do not administer active care services themselves but coordinate them. Patients and their caregivers are actively engaged in the care planning and execution. In contrast, the control group receives only usual discharge planning in the hospital and usual ambulatory care.The primary outcome is the all-cause readmission rate assessed using health insurance data within a follow-up of up to 12 months after hospital discharge. Secondary outcomes include care quality, mobility, nutritional and wound situation, and health-related quality of life. They are assessed at baseline, after 1 month, 3 months, 6 months, and at the end of study visit. Additionally, the economic efficiency of the intervention will be evaluated. ETHICS AND DISSEMINATION: Ethics approval for the trial was obtained from the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg. Results will be published in peer-reviewed, open-access scientific journals and disseminated at national and international research conferences and through public presentations in the geriatric and healthcare community. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03513159.
Subject(s)
Transitional Care , Aged , Germany , Hospitals , Humans , Patient Discharge , Quality of Life , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: The inclusion of transitional care professionals to improve the sectoral interface management is politically supported. The nine components of the transitional care model (TCM) originating from the USA, are used in a randomized controlled trial within the TIGER project, which is funded by the Federal Joint Committee of Germany. Geriatric patients are accompanied prior to discharge from hospital and up to 12 months after discharge in the home environment. OBJECTIVE: Within the framework of the TIGER project a nationwide survey was carried out on the use of the TCM components in the accompanied transition from hospital to home in the field of geriatrics. MATERIAL AND METHODS: A data collection was set up to establish contact with people from the immediate and care policy environment of geriatrics. In a 2-stage process, the first question was whether a geriatric project was known that focuses on the transition from hospital to home in geriatric patients. After confirmation, a questionnaire could be filled out online or by post. RESULTS: A total of 31 different projects out of 39 answered questionnaires were identified. Principally, all TCM components were used in the projects. The TCM component 9 that describes the coordination of support and aids, was mentioned most often (nâ¯= 30). The TCM components 6 (improvement in self-management) and 8 (promoting continuity) were used in only 19 projects. CONCLUSION: Management of the transsectoral transition is a current topic in the field of geriatrics in Germany. The TCM components that have proved to be important in reducing hospital readmission rates have predominantly been used in the projects.
Subject(s)
Transitional Care , Aged , Germany , Humans , Patient Discharge , Patient Readmission , Surveys and QuestionnairesABSTRACT
BACKGROUND: Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components' role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). METHODS: Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. RESULTS: Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). CONCLUSIONS: Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.
Subject(s)
Caregivers , Patient Care Team , Patient Readmission/statistics & numerical data , Transitional Care/standards , Aged , Aged, 80 and over , Female , Humans , Independent Living , Male , Self-ManagementABSTRACT
The article discusses the questions of the arbitration bodies according to § 111b SGB V (Volume V of the Social Insurance Code) in the individual federal states from the perspective of geriatric rehabilitation hospitals. The content of the agreement of reimbursement between a rehabilitation hospital and health insurance will be targeted as well as the question whether the entire content of the agreements of reimbursement can be negotiated at the arbitration body. In addition, the authors describe the consequences of the jurisprudence of the Federal Social Court on § 301 I. S. 1 no. 8 SGB V and the reaction of the lawgiver. Furthermore the authors describe the effects of the jurisprudence of the Federal Social Court regarding the minimum age associated with complex geriatric treatment (OPS 8-550).
