Patient Outcomes After Hospitalization in Acute Geriatric Unit (DAMAGE)

Risks of Death, Hospital Readmission, and Institutionalization After Hospitalization in Acute Geriatric Unit

Three events can be considered of major importance for patients after a hospitalization in an AGU: death, hospital readmission, and institutionalization. Current published data do not allow the clinician to simultaneously estimate the risk of hospital readmission, institutionalization and death of an older patient according to his/her characteristics and various complications that occurred during the hospitalization. However, clinicians often need to estimate these risks at hospital discharge to adapt their therapeutic choices, their proposals post-hospital care, and provide reliable and fair information to the patient and his relatives.

Estimating simultaneously the hazard for each of these three events can be complex. Indeed, a death event hinder the observation of re-hospitalization or institutionalization if death occurs before these events. The death should be considered a competing risk in these analyzes. Hospital readmission may modify the risk of death or institutionalization and should be considered as an intermediate factor for these event. This complexity cannot be accounted with classical statistical models, like logistic regression models.

The purpose of this study is to use more appropriate statistical models (multi-state models) to better estimate simultaneously the risks of hospital readmission, institutionalization, and death of a patient given after hospitalization in AGU, and to show that accuracy of these estimations can be improved by taking into account complications that occurred during the stay in AGU.

Study Overview

• Status: Completed
• Conditions: Geriatric Disorder

• Study Type: Observational
• Enrollment (Actual): 3532

Contacts and Locations

Study Locations

• France
  • Amiens, France
    • CHU d'Amiens
  • Beauvais, France
    • CH Beauvais
  • Caen, France
    • CHU Caen
  • Lille, France
    • Hôpital Cardiologique, CHRU
  • Lomme, France
    • GHICL, Saint Philibert
  • Saint quentin, France
    • CH Saint Quentin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 75 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All consecutive incident patients aged 75 years and older hospitalized in an acute geriatric unit will be eligible and included in the study.

Description

Inclusion Criteria:

• Age 75 years and over
• Hospitalized in Acute Geriatric Unit
• Covered by a health insurance

Exclusion Criteria:

• Refusal to participate to the study, as expressed by the patient or his/her next of kin

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of death after discharge	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of death after discharge		12 months
Number of rehospitalization after discharge		at 3 and 12 months
Number of institutionalization (NH admissions)		at 12 months
Number of nosocomial infectious diseases during the index hospitalization		60 days
Duration of clostridium difficile infection		60 days
Length of stay of the index hospitalization	The exact duration for this outcome will correspond to the duration of the index hospitalization	60 days

Collaborators and Investigators

• Sponsor: University Hospital, Lille
• Collaborators: Ministry of Health, France
• Investigators: Principal Investigator: Jean-Baptiste Beuscart, MD, PhD, University Hospital, Lille

Publications and helpful links

General Publications

• Deschasse G, Charpentier A, Prod'homme C, Genin M, Delecluse C, Gaxatte C, Gerard C, Bukor Z, Devulder P, Couvreur LA, Bloch F, Puisieux F, Visade F, Beuscart JB. Transition to Comfort Care Only and End-of-Life Trajectories in an Acute Geriatric Unit: A Secondary Analysis of the DAMAGE Cohort. J Am Med Dir Assoc. 2022 Sep;23(9):1492-1498. doi: 10.1016/j.jamda.2022.04.016. Epub 2022 May 21.
• Deschasse G, Bloch F, Drumez E, Charpentier A, Visade F, Delecluse C, Loggia G, Lescure P, Attier-Zmudka J, Bloch J, Gaxatte C, Van Den Berghe W, Puisieux F, Beuscart JB. Development of a Predictive Score for Mortality at 3 and 12 Months After Discharge From an Acute Geriatric Unit as a Trigger for Advanced Care Planning. J Gerontol A Biol Sci Med Sci. 2022 Aug 12;77(8):1665-1672. doi: 10.1093/gerona/glab217.

Study record dates

Study Major Dates

• Study Start (Actual): September 7, 2016
• Primary Completion (Actual): December 1, 2018
• Study Completion (Actual): December 1, 2018

Study Registration Dates

• First Submitted: August 23, 2016
• First Submitted That Met QC Criteria: October 27, 2016
• First Posted (Estimate): October 31, 2016

Study Record Updates

• Last Update Posted (Actual): August 24, 2020
• Last Update Submitted That Met QC Criteria: August 21, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Keywords: Mortality; Aged; Geriatric Assessment; Patient readmission
• Other Study ID Numbers: 2014_23; 2014-A01670-47 (Other Identifier: ID-RCB number, ANSM); API 13-19-002 (Other Identifier: PHRC number, DGOS)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No