Abstract
BackgroundIn our context, as in other European countries, care of patients with cognitive disorders or dementia still represents a major challenge in hospital settings. Thus, there is a need to ensure quality and continuity of care, avoiding preventable readmissions, which involve an increase in public expenses. Healthcare professionals need to acquire the necessary knowledge and skills to care for hospitalized patients with cognitive disorders and dementia.MethodsA quasi-experimental design with repeated observations, taken at baseline, post-intervention, and at one and three months post-intervention, in people hospitalized with cognitive disorders or dementia. The study will be carried out in four general hospitals in Spain and will include 430 PwD and their caregivers. The intervention was previously developed using the Balance of Care methodology where nurses, physicians, social workers and informal caregivers identified the best practices for this specific care situation. We aim to personalize the intervention, as recommended in the literature. The study has an innovative approach that includes new technologies and previous scientific evidence. Valid, reliable instruments will be used to measure the intervention outcomes. Quality of care and comorbidity will be analyzed based on the use of restraints and psychotropic medication, pain control, falls, functional capacity and days of hospitalization. Continuity of care will be measured based on post-discharge emergency hospital visits, visits to specialists, cost, and inter-sectorial communication among healthcare professionals and informal caregivers. Statistical analysis will be performed to analyze the effect of the intervention on quality of care, comorbidity and continuity of care for patients with dementia.DiscussionOur aim is to helping healthcare professionals to improve the management of cognitive disorders or dementia care during hospitalization and the quality of care, comorbidity and continuity of care in patients with dementia and their informal caregivers. Moving towards dementia-friendly environments is vital to achieving the optimum care outcomes.Trial registrationRegistered in Clinical Trials. ClinicalTrials.gov Identifier: NCT04048980 retrospectively registered on the 6th August 2019. https://clinicaltrials.gov/Protocol Record HCB/2017/0499.Sponsor: Hospital Clinic Barcelona.
Highlights
In our context, as in other European countries, care of patients with cognitive disorders or dementia still represents a major challenge in hospital settings
Acute hospital care of patients with dementia (PwD) needs to be redesigned so that it is tailored to their needs and those of their caregivers
We propose to design, implement and assess a multidisciplinary, multifactorial educational intervention called “CARExDEM”, based on the Balance of Care model (BoC) [24], addressed to nurses looking after hospitalized PwD in traumatology units
Summary
Design This is a quasi-experimental pre-post test, longitudinal, multicenter study. Data will be collected at hospital admission, discharge, 1 month follow-up (when visiting physician for surgery follow-up) and 3 month follow-up (See Fig. 1 for study overview). The research team organized two expert-panel meetings, inviting 20 healthcare professionals (nurses, physicians, physiotherapists, social workers and care assistants) with expertise in dementia, cognitive impairment and traumatology in hospitalization and primary care. They were divided into four groups and the research team provided each group with two clinical situations and a list of available resources and activities. Main outcome measures include quality of care and comorbidity (physical restraints, psychotropic medication, falls, functional capacity, pain assessment, length of hospital stay and number of readmissions); continuity of care (informal caregiver reaction, multidisciplinary and intersectoral communication) economic costs of hospital and community care and nurses’ level of knowledge in acute care of PwD. Multidisciplinary groups are currently working on the intervention at each hospital, following the BoC methodology
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