Optimal@NRW: optimized acute care of nursing home residents using an intersectoral telemedical cooperation network - study protocol for a stepped-wedge trial

David Brücken, Jenny Unterkofler, Sophie Pauge, Jonas Bienzeisler, Christian Hübel, Sebastian Zechbauer, Rolf Rossaint, Wolfgang Greiner, Birthe Aufenberg, Rainer Röhrig, Leo Cornelius Bollheimer, Optimal@NRW Research Group, Jörg Christian Brokmann, Julia Stingl, Martina Ziefle, Julia Offermann, Pia Erdmann, Albrecht Eisert, Lea Koech, Saskia Wilhelmy, Judith Steinfeld, Dominik Groß, Andreas Follmann, Michael Czaplik, Johannes Pollmanns, Thomas Krafft, Simone Böbel, Maresa Neuerer, David Brücken, Jenny Unterkofler, Sophie Pauge, Jonas Bienzeisler, Christian Hübel, Sebastian Zechbauer, Rolf Rossaint, Wolfgang Greiner, Birthe Aufenberg, Rainer Röhrig, Leo Cornelius Bollheimer, Optimal@NRW Research Group, Jörg Christian Brokmann, Julia Stingl, Martina Ziefle, Julia Offermann, Pia Erdmann, Albrecht Eisert, Lea Koech, Saskia Wilhelmy, Judith Steinfeld, Dominik Groß, Andreas Follmann, Michael Czaplik, Johannes Pollmanns, Thomas Krafft, Simone Böbel, Maresa Neuerer

Abstract

Background: Increasing life expectancy is associated with a growing number of people living in nursing homes, while the availability of outpatient medical care, especially from family doctors, is stagnating in this sector. Consequently, numerous and often avoidable, low-threshold hospitalizations of nursing home residents are observed. This results in unnecessary use of resources such as emergency services and emergency rooms as well as in potential health risks to the nursing home residents related to hospitalization. This study aims to improve this healthcare gap by implementing an intersectoral telemedicine approach.

Methods: Twenty-five nursing homes are participating and provided with telemedical equipment to perform teleconsultations. Additionally, an early warning system and a digital patient record system are implemented. Telephysicians based at RWTH Aachen University Hospital are ready to support the nursing homes around the clock if the family doctor or an emergency service practice is not available in time. Mobile non-physician practice assistants from the telemedicine centre can be dispatched to perform delegable medical activities. General practitioners and the medical emergency practices also have access to the telemedical infrastructure and the non-physician practice assistants.

Discussion: Optimal@NRW adds a telemedicine component to standard care - combining elements of outpatient and inpatient health care as well as emergency service practices - to enable timely medical consultation for nursing home residents in case of the development of an acute medical condition. In addition to optimized medical care, the goal is to reduce unnecessary hospital admissions. The intersectoral approach allows for the appropriate use of resources to match the individually needed medical treatment.

Trial registration: ClinicalTrials.gov NCT04879537 . Registered on May 10, 2021.

Keywords: Ambulatory care-sensitive hospitalizations; Geriatrics; Hospital admission; Nursing home; Outpatient care; Teleconsultation; Telemedicine; Telephysician.

Conflict of interest statement

The authors declare that they have no competing interests

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The stepped-wedge design
Fig. 2
Fig. 2
Cluster-based participant timeline
Fig. 3
Fig. 3
Data flow concept

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