Clinical Assessment and Treatment in the Nursing Home as an Alternative to Hospital Admission

Description

This multicenter, cluster-randomized, unblinded quality-improvement study evaluates whether home-based clinical assessment by municipal acute care teams can safely reduce hospital admissions among nursing home residents experiencing acute illness or clinical deterioration during out-of-hours periods. Participating nursing homes in the Capital Region of Denmark will be randomized to either usual care (contacting the regional medical helpline, 1813) or the intervention pathway, in which nursing home staff contact a municipal acute care team directly. The acute care team performs an on-site clinical assessment and, when needed, consults a senior physician in the hospital emergency department to establish a treatment and observation plan, which may include continued management at the nursing home under hospital responsibility. The study compares the intervention with usual care with respect to hospital admissions and mortality among nursing home residents.

Interventions

• Home-based Clinical Assessment and Treatment (Other)
  Nursing homes in the intervention group will, if a resident experiences acute illness or clinical deterioration, call the municipal acute care team directly. They will then do a home-based clinical assessment and, if deemed necessary, consult a senior physician in the hospital emergency or geriatrics department to establish a treatment and observation plan.

Eligibility criteria

Conditions

Locations

• Copenhagen University Hospital - Bispebjerg and Frederiksb — Copenhagen, Denmark
• University Hospital of Copenhagen Herlev — Herlev, Denmark
• Copenhagen University Hospital - North Zealand Hospital — Hillerød, Denmark
• University Hospital of Copenhagen Amager and Hvidovre — Hvidovre, Denmark