Abstract
BackgroundThe 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.MethodsThe 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.ConclusionA 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 registrationGerman Clinical Trials Register: DRKS00017129. Registered on 23 April 2019. https://www.drks.de/drks_web/setLocale_EN.do.
Highlights
One in four people in need of long-term care in Germany lives in a nursing home (NH) [1]
A further critical consequence is that they have difficulties in following therapy instructions [6], which can lead to adverse drug events (ADEs) that are widely shown to be potentially avoidable [7, 8]
A cross-sectional study on utilization patterns following the ambulatory care sensitive conditions (ACSC) approach shows a significantly higher proportion of Potentially avoidable hospitalization (PAH) among NH residents (27%) compared to people living at home (15%) [15]
Summary
One in four people in need of long-term care in Germany lives in a nursing home (NH) [1]. Considering the aging German population, this development is most likely to continue over future decades [1, 2] These findings are supported by studies that show an increasing proportion of NH residents with multimorbidity and a high death rate during their first 12 months in residential care [3,4,5]. The joint planning implies that, in exceptional cases, patients might be treated by doctors other than their family doctor, for example, as part of the on-call duty or the pre-weekend visit. This way, a quick response can be made in critical situations. Its effectiveness, cost-effectiveness, and safety will be evaluated
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