A complex health services intervention to improve medical care in long-term care homes: study protocol of the controlled coordinated medical care (CoCare) study

Abstract

Background Deficits in general and specialized on-site medical care are a common problem in nursing homes and can lead to unnecessary, costly and burdensome hospitalizations for residents. Reasons for this are often organizational obstacles (such as lack of infrastructure or communication channels) and unfavorable compensation structures, which impede the implementation of adequate medical care. The purpose of this study is to evaluate a complex intervention aiming to improve the coordination of medical care in long-term care nursing homes in Germany. The project aims to optimize the collaboration of nurses and physicians in order to reduce avoidable hospital admissions and ambulance transportations. Methods/design In a prospective controlled trial, nursing home residents receiving a complex on-site intervention are compared to residents receiving care/treatment as usual. The study will include a total of around 4000 residents in approximately 80 nursing homes split equally between the intervention group and the control group. Recruitment will take place in all administrative districts of Baden-Wuerttemberg, Germany. The control group focuses on the administrative district of Tuebingen. The intervention includes on-site visits by physicians joined by nursing staff, the formation of teams of physicians, a computerized documentation system (CoCare Cockpit), joint trainings and audits, the introduction of structured treatment paths and after-hours availability of medical care. The project evaluation will be comprised of both a formative process evaluation and a summative evaluation. Discussion This study will provide evidence regarding the efficacy of a complex intervention to positively influence the quality of medical care and supply efficiency as well as provide cost-saving effects. Its feasibility will be evaluated in a controlled inter-regional design. Trial registration WHO UTN: U1111–1196-6611 ; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017/08/23). Electronic supplementary material The online version of this article (10.1186/s12913-019-4156-4) contains supplementary material, which is available to authorized users.

Implementation of a Complex Health Services Intervention in Long-term Care Homes: A Process Evaluation Using Focus Groups

“…Participants were supplied with information on the aim of the focus group interviews and written informed consent was obtained from all participants. As the project team used various methods for the process evaluation (15), some of the participants and researchers knew each other from previous contacts.…”

“…Focus groups were conducted using a half-structured modular guideline, assessing the opinion of participants towards the different aspects of the project (see Brühmann, Reese (15) for a description of the project). A modular guideline was chosen as CoCare comprises many modules and using a modular guideline, participants were able to pick which of the many aspects within the intervention were particularly important to discuss.…”

“…A modular guideline was chosen as CoCare comprises many modules and using a modular guideline, participants were able to pick which of the many aspects within the intervention were particularly important to discuss. The interview guideline was developed for this study by the authors based on the study design of CoCare (15) and the expertise of the scientists (see Additional File 1). The interview guideline was also previously published in Brühmann, Reese (15).…”

“…However, the implementation of primary care in NHs is hindered by the lack of infrastructure or insu cient compensation of physicians. Project CoCare ("coordinated medical care") aims to bridge the gap by implementing a complex health care intervention to improve primary care in NHs (15). The study takes place in the federal state of Baden-Wuerttemberg, Germany, with 31 NHs implementing the new intervention, providing it to approximately 1,150 residents.…”

“…See Figure 1 for an overview of all modules of the project. Further information on the project and its study design has been published elsewhere: Brühmann, Reese (15).…”