Effect of an interprofessional care concept on the hospitalization of nursing home residents: study protocol for a cluster-randomized controlled trial

Abstract

Background The rising number of nursing home (NH) residents and their increasingly complex treatment needs pose a challenge to the German health care system. In Germany, there is no specialized geriatric medical care for NH residents. Nursing staff and general practitioners (GPs) in particular have to compensate for the additional demand, which is compounded by organizational and structural hurdles. As a result, avoidable emergency calls and hospital admissions occur. In the SaarPHIR project (Saarländische PflegeHeimversorgung Integriert Regelhaft), a complex intervention focusing on a medical care concept was developed in a participatory practice-based approach involving NH representatives and GPs. The complex intervention addresses the collaboration between nurses and GPs and aims to help restructure and optimize the existing daily care routine. It is expected to improve the medical care of geriatric patients in NHs and reduce stressful, costly hospital admissions. The intervention was pilot-tested during the first 12 months of the project. In the present study, its effectiveness, cost-effectiveness, and safety will be evaluated. Methods The study is a cluster-randomized controlled trial, comparing an intervention group with a control group. The intervention includes a concept of interprofessional collaboration, in which GPs group into regional cooperating teams. Teams are encouraged to cooperate more closely with NH staff and to provide on-call schedules, pre-weekend visits, joint team meetings, joint documentation, and improved medication safety. At least 32 NHs in Saarland, Germany (with at least 50 residents each) will be included and monitored for 12 months. The primary endpoint is hospitalization. Secondary endpoints are quality of life, quality of care, and medication safety. The control group receives treatment as usual. Process evaluation and health economic evaluation accompany the study. The data set contains claims data from German statutory health insurance companies as well as primary data. Analysis will be conducted using a generalized linear mixed model. Conclusion A reduction in hospital admissions of NH residents and relevant changes in secondary endpoints are expected. In turn, these will have a positive impact on the economic assessment. Trial registration German Clinical Trials Register: DRKS00017129. Registered on 23 April 2019. https://www.drks.de/drks_web/setLocale_EN.do.

Cost–benefit analysis of the CoCare intervention to improve medical care in long-term care nursing homes: an analysis based on claims data

“…A comparison of our results with existing literature is difficult, since as of yet no similar interventions with published results of claims data from German SHIs exist. Comparable studies in NHs report only fragments of cost or focus on specific illnesses or items such as hospitalization and have not published any results yet [33,35]. However, data from international studies evaluating similar interventions to reduce hospitalisations or costs also showed promising results [50][51][52].…”

Intersektoralität im Fokus – Strategien und aktuelle Forschungsprojekte zur Versorgung geriatrischer Personen

“…Im Saarland zielt das Projekt SaarPHIR – Saarländische Pflegeheimversorgung Integriert Regelhaft auf die verbesserte Zusammenarbeit von Ärzten und Pflegekräften, indem fest zugeordnete regionale Versorgerteams gebildet werden, die sich regelmäßig über die Bewohner austauschen (inklusive Arzneimittelüberprüfung; [ 33 ]). Die teilnehmenden Ärzte können so Ressourcen bündeln und eine verbesserte Erreichbarkeit für die Pflegeheime realisieren.…”

Pflegeheim-sensitive Krankenhausfälle und Ansätze zur Verringerung der Hospitalisierung von Pflegeheimbewohnerinnen und -bewohnern

“…Zu den zeitnah umzusetzenden Handlungsempfehlungen gehören die berufsgruppenübergreifende Kommunikation, Kooperation und Beratung, die zu einer verbesserten Patientensicherheit führen [ 47 ] und eine Reduktion der Hospitalisierungen aus dem Pflegeheim erwarten lassen [ 27 , 32 , 34 ]. Eine erste Inventarisierung von Kooperationen zwischen Ärzteschaft und Pflegefachpersonal in Deutschland lieferte mögliche Ansatzpunkte für Verbesserungen [ 29 ].…”

“…fachärztliche Ressourcen gebündelt werden. Eine geschulte Pflegefachperson in der Pflegeinrichtung ist dabei Ansprechpartner für die Ärzteschaft [ 34 ].…”