Improving continuity of patient care across sectors: study protocol of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)

Abstract

Background Hospitalisations are a critical event in the care process. Insufficient communication and uncoordinated follow-up care often impede the recovery process of the patient resulting in a high number of rehospitalisations and increased health care costs. The overall aim of this study is the development, implementation and evaluation of a structured programme (VESPEERA) to improve the admission and discharge process. Methods We will conduct an open quasi-experimental multi-centre study with four intervention arms. A cohort selected from insurance claims data will serve as a control group reflecting usual care. The intervention will be implemented in 25 hospital departments and 115 general practices in 9 districts in Baden-Wurttemberg. Eligibility criteria for patients are: age > 18 years, hospital admission or hospitalisation, insurance at the sickness fund “AOK Baden-Wurttemberg”, enrolment in general practice-centred care contract. Each study arm will receive different intervention components based on the point of study enrolment and the patient’s medical need. The interventions comprise a) a structured assessment in the general practice prior to admission resulting in an admission letter b) a discharge conversation by phone between hospital and general practice, c) a structured assessment and care plan post-discharge and d) telephone monitoring for patients with a high risk of rehospitalisation. The assessments are supported by a software tool (“CareCockpit”), originally developed for structured case management programmes. The primary outcome (rehospitalisation due to the same indication within 90 days) and a range of secondary outcomes (rehospitalisation due to the same indication within 30 days; hospitalisations due to ambulatory care-sensitive conditions; delayed prescription of medication and medical products/ devices and referral to other health practitioner/s after discharge; utilisation of emergency or rescue services within 3 months; average care cost per year and patient participating in the VESPEERA programme) and quality indicators will be determined based on insurance claims data and CareCockpit data. Additionally, a patient survey on satisfaction with cross-sectoral care and health related quality of life will be conducted. Discussion Based on the results, area-wide implementation in usual care is well sought. This study will contribute to an improvement of cross-sectoral care during the admission and discharge process. Trial registration DRKS00014294 on DRKS / Universal Trial Number (UTN): U1111–1210-9657, Date of registration 12/06/2018.

The role of personalised professional relations across care sectors in achieving high continuity of care

“…The VESPEERA project aims at improving admission and discharge management in hospitals and general practices in Germany [ 19 ]. The intervention program includes intervention components in general practices and hospitals before admission, during hospital stay as well as before and after discharge, such as an admission letter, a telephonic conversation before discharge, and telephone follow-up for patients at high risk for rehospitalisation.…”

Improving continuity of patient care across sectors: study protocol of the process evaluation of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)

“…It develops, implements and evaluates a structured hospital admission and discharge programme between general practices and hospitals to avoid interruptions in the hospital admission and discharge process. An overview on the intervention components and the outcomes evaluation is given down below and is described in detail elsewhere 5. Subsequently, we first summarise the patient-directed interventions in the VESPEERA programme (Improving continuity of patient care across sectors: An admission and discharge model in general practices and hospitals, Versorgungskontinuitaet sichern: Patientenorientiertes Einweisungs- und Entlassmanagement in Hausarztpraxen und Krankenhauesern ), the VESPEERA outcomes evaluation and the implementation strategies.…”

“…The VESPEERA programme is ‘expected to reduce the number of avoidable rehospitalisations and emergency care contacts, to improve patient safety and patient involvement, to reduce overuse, underuse and misuse of health care, to improve the continuity of care and to improve interprofessional and cross-sectoral communication between patients, hospitals, general practices and the sickness fund “Allgemeine Ortskrankenkasse (AOK) Baden-Wurttemberg”’ 5…”

“…The change of the primary outcome (before vs after the intervention) of each intervention group will be pairwise compared with the control group. A detailed description of the outcomes evaluation can be found in the corresponding study protocol 5…”

“…remuneration systems). The effects of the interventions cover a range of domains 5. Furthermore, hospitals are involved in the implementation within their organisation to tailor it to their local processes and structures.…”