RECRUITINGINTERVENTIONAL

Hospital at Home for Elderly Acute Ill Patients

Improving and Evaluation of a New Cross-sectoral Hospital at Home Model for Elderly Acute Ill Patients

About This Trial

Many elderly patients with uncomplicated treatment courses are admitted unnecessarily, which is a burden for the patient and society. Studies show that Hospital at Home (HaH) treatment is an alternative to hospitalization. The patient's risk of delirium, infection and loss of function is reduced when the patient avoids the hospital stay. HaH treatment is expected to be more cost-effective, improve patients' functional abilities and patients' satisfaction. Three municipalities, general practitioners, pre-hospital service and an emergency department (ED) in Central Denmark Region have organized the first HaH treatment model across disciplines and sectors. Specialists in the ED and the municipal acute teams provide HaH treatment for elderly acute ill patients. However, the model has not yet been evaluated. The aim of this study is to optimize the HaH treatment model for elderly acute ill patients. The objective is to increase patient satisfaction and optimize the use of resources in healthcare by avoiding unnecessary hospitalizations that impair and prolong treatment. This study is an open label randomized controlled trial (RCT) with a 1:2 allocation ratio of acute hospital admission versus HaH. During a pilot period, we tested and adapted the patient pathway of HaH to the practical reality, before we start the randomization for the RCT study. We will investigate the clinical effects and health economic consequences of HaH treatment compared with standard hospital treatment.

Who May Be Eligible (Plain English)

Who May Qualify: - The patient should be aged 65 and over - Diagnosed with a stable acute medical conditions e.g. cystitis, erysipelas, pneumonia - The patient should be living in their own home or a nursing home before entering the study - The patient should be residing in one of the three municipalities (Viborg, Skive and Silkeborg) - The patient must have been seen by the GP or the pre-hospital service in the case of disease in question - The patient should speak and understand Danish. - The patient should give willing to sign a consent form to participate in the study. Who Should NOT Join This Trial: - The patient is unable to give written consent - The capacity of the municipal acut team care was fully utilised. Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language

Inclusion Criteria: * The patient should be aged 65 and over * Diagnosed with a stable acute medical conditions e.g. cystitis, erysipelas, pneumonia * The patient should be living in their own home or a nursing home before entering the study * The patient should be residing in one of the three municipalities (Viborg, Skive and Silkeborg) * The patient must have been seen by the GP or the pre-hospital service in the case of disease in question * The patient should speak and understand Danish. * The patient should give informed consent to participate in the study. Exclusion Criteria: * The patient is unable to give written consent * The capacity of the municipal acut team care was fully utilised.

Treatments Being Tested

OTHER

Hospital at Home (HaH) treatment

The intervention is a new pathway of providing acut treatment for elderly acute ill patients in their own home. If the patient is randomized to the intervention group, the municipalities acute teams start the treatment. The acute team can take venous blood tests, ECG and bladder scan at home. The acute team handles the treatment at home and follows the patient closely. During the treatment course, the acute team and the ED specialist discuss the treatment process either over the phone or virtually on an iPad, where the patient is also involved. If the specialist would like to see the patient for assessment or send the patient for an X-ray, the specialist informs the acute team that the patient must go to a short check-up in the ED. Here, the specialist examines the patient himself and assesses whether the patient can continue to be treated at home, or whether the patient must be admitted to the hospital due to deterioration of the condition.

OTHER

Standard hospital admission

The active comparator is the standard hospital admission for elderly acute ill patients.

Locations (3)

Silkeborg municipality

Silkeborg, Denmark

Skive municipality

Skive, Denmark

Viborg municipality

Viborg, Denmark