Prevention and Recovery: an individual-based, fully integrated intervention to prevent loss of function after hospitalisation
Description
Elderly people who end up in the hospital run a significant risk of developing hospital-related loss of function in addition to the primary reason for the hospitalisation. The ‘Prevention and Recovery’ care programme is an intervention designed to combat hospital-related loss of function. This programme is a part of GENERO and the National Elderly Care Programme.
The goal of the programme is to ensure early detection of risk factors as regards unnecessary loss of function, to prevent further loss of function through preventive interventions, and to promote a speedy return home with retention of recovery once there.
The programme also seeks to reduce the burden on carers and to improve the quality of care in terms of both content and process.
The programme organises existing treatment methods and processes for reactivating vulnerable elderly people in a way that is better geared to the needs of the elderly and thus produces better effects for both the elderly people and their carers.
The ‘Prevention and Recovery’ programme has three components:
- Early start: reactivating treatment starts within 48 hours of hospitalisation;
- Intensive follow-up treatment (at the Centre for Prevention and Recovery (CPH) for some frail elderly people);
- Intensive primary follow-up care aimed at reactivation and the retention of function at home with the help of a case manager with geriatric expertise. This treatment uses a fully integrated, multidisciplinary, goal-oriented and methodical approach (Goal Attainment Scaling).
Project leader and secretary:
- Prof. J.P. Mackenbach, Public Health Department, PhD, Erasmus MC
For more information:
Prof. Ewout Steyerberg, PhD, Professor of Medical Decision-Making
Public Health Department
Erasmus MC
Tel. +31 (0)10 703 8470
E-mail: e.steyerberg@erasmusmc.nl
GENERO website
Assessment study
Primary question
The primary question is whether the ‘Prevention and Recovery’ programme for frail elderly people who have been hospitalised results in better-quality care that is cost-effective compared to ordinary Dutch geriatric care (with or without clinical geriatrics and with or without hospital-at-home care).
Organisation of the study
Qualitative and quantitative research methods in a quasi-experimental research design will be used to assess the ‘Prevention and Recovery’ programme. The effects on ‘GENERO’ – Transition Experiment Prevention and Recovery Care Programme 3: the Functioning and Quality of Life of Elderly People’ will be measured in a prospective cohort study, and the CPH will be assessed by means of a randomised controlled trial (RCT).
Settings
The study will involve three types of hospitals with various levels of geriatric care:
- a hospital without clinical geriatrics, hospital-at-home care and follow-up primary care (Ruwaard van Putten, Spijkenisse);
- a hospital with clinical geriatrics and hospital-at-home care/care hotel, but without follow-up primary care (St. Franciscus Hospital with De Stromen Opmaat Group, Rotterdam);
- a hospital with clinical geriatrics and the ‘Prevention and Recovery’ programme including in primary care (Vlietland Hospital and the Argos Care Group, Nieuwe Waterweg Noord region).
Study groups
Over the course of one year, the total inflow of patients aged 65 and older (7,000 per location) will be triaged by means of the ISAR to identify frail elderly patients (4,500 per location). From this group, a random sample of 900 frail elderly will be compiled per location. At the intervention location, an additional 400 frail elderly who are eligible for CPH will be identified. This group will be randomised for the ‘Prevention and Recovery’ programme, including or excluding a stay at the CPH.
Follow-up and data collection
Data will be collected at the time of hospitalisation, as well as 3 and 12 months after hospitalisation, on the primary outcome benchmarks for elderly patients and their carers (physical functioning, quality of life and experience of burden), loss of function risk factors and indicators of the care process.
For a good assessment of the effects of the ‘Prevention and Recovery’ programme, quantitative process indicators will be measured that are related to the treatment integrity of the programme (e.g. the disciplines involved in the treatment).
In addition, an audit will be performed to get a detailed picture of the quality of the care provided and the care process in the three settings. The outcomes at 3 and 12 months will be compared between the three locations, statistically correcting for differences in case mix and treatment regimes (‘confounders’).
Researchers
- Prof. A. Nieboer, PhD
- Annemarie de Vos, PhD
- Jacqueline Hartgerink, PhD
- Marc Koopmanschap, PhD
- Jeroen van Wijngaarden, PhD
- Kirsten J.E. Asmus-Szepesi
- Prof. Ewout W. Steyerberg, PhD
- Linda Flinterman, PhD
Sponsor
Partners
Project group:
- Public Health Department, Erasmus MC
- Institute for Medical Technology Assessment, Erasmus University Rotterdam
- VU University Medical Centre Amsterdam
- Argos Care Group
- Vlietland Hospital
Participating hospitals:
- Ruwaard van Putten
- Vlietland Hospital
- St. Fransciscus Gasthuis and De Stromen Opmaat Group
- Argos Care Group