Effectiveness and Organizational Conditions of Effectiveness of Telemedicine in Establishments Providing Care for the Dependent Elderly (EFFORT)

Study of interest of Telemedicine in establishments providing care for the dependent elderly (EHPAD in french) is a strategy for improving the course of care of residents, including the number not programmed hospitalizations, and a multidimensional analysis of the conditions of effectiveness of telemedicine will identify the keys to optimize its use.

Study Overview

• Status: Completed
• Conditions: Health Services for the Aged
• Intervention / Treatment: Procedure: Evaluation of disease and follow-up

Detailed Description

The project combines quantitative and qualitative analyses :

1. Quantitative study

Study of comparative prospective cohort clustered in two parallel groups:

Group 'Telemedicine': establishments providing care for the dependent elderly (EHPAD in french) equipped for telemedicine (teleconsultation, casualty) as part of the regional project of the Aquitaine Regional Agency of Heath telemedicine device deployment.

Control group: Defined and equipped for telemedicine EHPAD after matching on the number of residents, the GMP (average weighted GIR : "Groupes Iso Ressources" = score to reflects the average level of dependency of residents of a residential care facility for the elderly), the PMP (weighted average PATHOS = an evaluation system set up by the National Union of Clinical Gerontology and the Medical Service of the National Fund for Health Insurance for Salaried Workers), the distance to a hospital with an emergency shelter service.

The rate of unscheduled hospitalizations will be collected during follow-up visits in clinical departments of the healthcare of the Gironde (french department) by a research staff.

2 Qualitative study In the Group of nursing homes with telemedicine, said group "Telemedicine", will be identified four long-term care facilities, selected according to their degree of use of telemedicine (ratio number of teleconsultation per month / number of beds) (EHPAD 2 strong users, 2 nursing homes) low users) within these four long-term care facilities will be carried out observations of field and in-depth interviews with professionals, managers and attending physicians.

• Study Type: Observational
• Enrollment (Actual): 373

Contacts and Locations

Study Locations

• France
  • Arsac, France, 33460
    • EHPAD Le home medocain Arsac
  • Bordeaux, France, 33000
    • EHPAD Henry Dunant
  • Bordeaux, France, 33000
    • EHPAD Le Clos Serena
  • Bordeaux, France, 33000
    • EHPAD Résidence les Carmes
  • Bordeaux, France, 33082
    • EHPAD Cos villa Pia
  • Bordeaux, France, 33200
    • EHPAD Grand Bon Pasteur
  • Bordeaux, France, 33200
    • EHPAD Residence Aime Cesaire
  • Bordeaux, France, 33300
    • EHPAD Le Platane du Grand Parc
  • Bègles, France, 33130
    • EHPAD Le parc du Bequet
  • Bègles, France, 33130
    • EHPAD Manon Cormier
  • Cestas, France, 33610
    • EHPAD Seguin
  • Fronsac, France, 33126
    • EHPAD résidence du Tertre
  • Gradignan, France, 33170
    • EHPAD Douceur de France
  • Gujan-Mestras, France, 33470
    • EHPAD Résidence l'Arousiney
  • Lamarque, France, 33460
    • EHPAD Le rétou
  • Lormont, France, 33310
    • EHPAD Les coteaux
  • Mérignac, France, 33700
    • Résidence de Médicis
  • Pessac, France, 33600
    • EHPAD Fontaudin
  • Rauzan, France, 33420
    • EHPAD Villa presentine
  • Saint Seurin sur l'Isle, France, 33660
    • EHPAD Jacqueline Auriol
  • Talence, France, 33110
    • EHPAD Résidence La berge du lac
  • Talence, France, 33400
    • EHPAD Villa Bontemps
  • Villenave-d'Ornon, France, 33140
    • EHPAD Home Marie Curie
  • Lormont
    • Pessac, Lormont, France, 33600
      • EHPAD CHU Bordeaux

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All residents of EHPAD, men and women 65 years of age and more and likely to be eligible for a teleconsultation as suffering from one of the identified chronic pathologies as a reason for teleconsultation by Regional Agency of Hearth, will be included in the study in two groups of long-term care facilities. Eligible residents will be included in a very short time of 3 months.

Description

Inclusion Criteria:

Quantitative research:

• All residents of nursing home men and women 65 years of age and more and likely to be eligible for a teleconsultation or a casualty because achieved one of the identified chronic pathologies as a reason for teleconsultation, will be included in both groups of long-term care
• Medical professionals working in the nursing home agreeing to answer the specifics questionnaires

Qualitative study:

• Doctors, physicians and coordinators nurses of Establishments Providing Care for the Dependent Elderly, nurses, orderly, psychologists, directors of Establishments
• Having a professional activity in nursing homes selected
• Having given their consent to participate in the study

Exclusion Criteria:

• Residents of long-term care facilities (quantitative study) Resident (or guardian/person) who expressed his opposition to participate in the study or not likely to be eligible for a teleconsultation or casualty Establishments Providing Care for the Dependent Elderly (qualitative) professionals
• Professional who expressed his opposition to participate in the study

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Establishments with telemedicine system; Establishments equipped for telemedicine (teleconsultation, casualty) as part of the regional project of the Aquitaine regional program telemedicine device deployment.	Procedure: Evaluation of disease and follow-up; Correspondence medical consultation with specific device; Other Names: Telemedicine
Establishments without telemedicine system; Defined and equipped for telemedicine EHPAD after mating on the number of residents, the GMP (average weighted GIR), the PMP (weighted average PATHOS), the distance to a hospital with an emergency shelter service. The rate of unscheduled hospitalizations will be collected during follow-up visits in clinical departments of the healthcare of the Gironde by a research staff	Procedure: Evaluation of disease and follow-up; Correspondence medical consultation with specific device; Other Names: Telemedicine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of hospitalization not programmed residents on Medicine Surgery obstetrics (MCO)	Number of hospitalizations not programmed residents on Medicine Surgery obstetrics (MCO) between the inclusion and 12 month	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the main diagnosis, coded by the International Classification of diseases for every hospitalization	Evaluate the number of inappropriate hospitalization. The inappropriate hospitalization will be performed using the classification of Weissman. Weissman classification identifies causes of potentially preventable hospitalizations, from the main diagnosis, coded by the International Classification of diseases, version 10 (ICD10).	12 months
Score of the specific questionnaire for measurement of the context organizational and Managerial in health care facilities	Evaluate the impact of a strategy issued in EHPAD type teleconsultation or casualty on the quality of work life	12 months

Collaborators and Investigators

• Sponsor: University Hospital, Bordeaux
• Investigators: Principal Investigator: Nathalie SALLES, MD, PhD, University Hospital, Bordeaux; Study Chair: Florence SALLIOUR, PhD, University Hospital, Bordeaux

Publications and helpful links

General Publications

• Han JH, Morandi A, Ely EW, Callison C, Zhou C, Storrow AB, Dittus RS, Habermann R, Schnelle J. Delirium in the nursing home patients seen in the emergency department. J Am Geriatr Soc. 2009 May;57(5):889-94. doi: 10.1111/j.1532-5415.2009.02219.x.
• Morandi A, Han JH, Callison C, Ely EW, Schnelle JF. Delirium in nursing home residents across care transitions: a preliminary report. J Am Geriatr Soc. 2009 Oct;57(10):1956-8. doi: 10.1111/j.1532-5415.2009.02472.x. No abstract available.
• Vellas B. Integrating Frailty into Clinical Practice to Prevent the Risk of Dependency in the Elderly. Nestle Nutr Inst Workshop Ser. 2015;83:99-104. doi: 10.1159/000382092. Epub 2015 Oct 20.
• Graverholt B, Forsetlund L, Jamtvedt G. Reducing hospital admissions from nursing homes: a systematic review. BMC Health Serv Res. 2014 Jan 24;14:36. doi: 10.1186/1472-6963-14-36.
• Salles N, Saillour-Glenisson F, Sibe M, Langlois E, Kret M, Durrieu J, Arditi N, Abraham M, Perry F. Effectiveness and organizational conditions of effectiveness of telemedicine in nursing homes. A study protocol of a comparative prospective cohort (EFFORT study). Digit Health. 2021 Jan 24;7:2055207620982422. doi: 10.1177/2055207620982422. eCollection 2021 Jan-Dec.

Study record dates

Study Major Dates

• Study Start (ACTUAL): November 1, 2017
• Primary Completion (ACTUAL): July 12, 2019
• Study Completion (ACTUAL): July 12, 2019

Study Registration Dates

• First Submitted: January 23, 2018
• First Submitted That Met QC Criteria: March 27, 2018
• First Posted (ACTUAL): April 3, 2018

Study Record Updates

• Last Update Posted (ACTUAL): January 7, 2020
• Last Update Submitted That Met QC Criteria: January 6, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Other Study ID Numbers: CHUBX 2016/32

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