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CONNECARE-Assuta-Case Study 1

26. oktober 2017 opdateret af: Dr Bellaa Azria, Assuta Medical Center

Integrated Personalized Connected Care for Complex Chronic Patients - Community-based Management

The European Union's Horizon 2020 project issued a Call for Action [1] in December 2013 to design, develop, disseminate and evaluate new IT technologies for use in integrative treatment processes, with emphasis on complex adult patient. Assuta Hospital submitted a proposal for this call, as part of a broad consortium of 10 participants from various European countries.

The CONNECARE consortium has formulated a general model for integrative treatment, and is currently in the technological development stages, to create a smart (supportive decision) and adaptive system that supports integrative treatment processes both in the hospital and in the community for personalized treatment in complex chronic patients. The development includes a significant integrative component of self-care management by the patient and / or the primary caregiver.

Following the completion of the technological development, clinical trials will be held in four organizations throughout Europe - Assuta Hospital in Ashdod in cooperation with the Maccabi community in Ashdod, two centers in Catalonia and the Groningen region in the Netherlands. The purpose of the studies is to assess the impact of the implementation of the model, processes and digital tools that will be built during the project.

Studieoversigt

Status

Ukendt

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

The intervention in this study consists of two parts:

  1. Integrative treatment in the community, which includes a close follow-up with a coordinating nurse for three months after discharge from the hospital.
  2. Empowering the patient to self-manage his or her health by using applications for smart devices.

The study protocol:

  1. Recruitment of participants during the patient's hospitalization after the patient is identified as a complex patient, explanation of the study and signing the consent form.
  2. Evaluation process for the patient, using valid questionnaires, in order to determine the baseline level at the entrance to the study.
  3. Distribution of research kit and related accessories and training.
  4. Close monitoring for three months in the community after discharge from the hospital and use of the research kit.
  5. Reassessment of the patient at the exit of the study.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

220

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

65 år og ældre (Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • All Maccabi members who arrive at the ER in an unplanned manner
  • Age over 65
  • Living in a home and not in a nursing home
  • LACE> 7

  • At least three of the following conditions:

    • Multiple drugs - regular use of four or more drugs
    • More than one case of hospitalization or visit to the ER in the past year
    • Malnutrition
    • Elements of low socio-economic status
  • The patient and / or the main caregiver speak Hebrew, English or Russian
  • The patient or primary caregiver has a password to the Maccabi Online website
  • The patient and / or the primary caregiver have basic technological knowledge in the use of the applications
  • The patient has wireless Internet access at home (via Wifi or through a cellular connection)

Exclusion Criteria:

  • Patients with cognitive or dementia problems

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Sundhedstjenesteforskning
  • Tildeling: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Intervention group
Implementing the Connecare system to support integrated care for complex patients with an unplanned admission to Assuta Ashdod who are discharged back to the community with an emphasis on Connecare self managment system for the patient and close follow up and coordination of all of the medical, health and social care in the community by a Maccabi integrated care nurse for a period of 3 months post discharge.
Enhed: Connecare self managment system
The CONNECARE SMS will rely on a hybrid solution that, besides being autonomous (the patient may use the SMS to monitor and access to her/his data and information), has also a collaborative component (through the interaction with the SACM) to allow participation by clinicians and to provide feedback to them. In so doing, the patient may control her/his activity, receiving recommendations to improve the treatment and to be encouraged in following it.
Ingen indgriben: Matched control group
The control group will be selected from Maccabi's database and will be patients who are matched 1:1 with the intervention sample and live in another community similar to Ashdod in socioeconomic characteristics who undergo the same elective major surgery in other hospitals

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Re-Hospitalizations and emergency room visits in the short term after discharge from the hospital
Tidsramme: One month
Number of hospitalizations and emergency room visits after discharge
One month
Re-Hospitalizations and emergency room visits in the long term after discharge from the hospital
Tidsramme: One year
Number of hospitalizations and emergency room visits after discharge
One year
Length of hospitalization
Tidsramme: Less then one month
In days
Less then one month

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Compliance with the assignments in the discharge program guidelines
Tidsramme: One year
At the time of discharge from the hospital, the patient receives a list of tasks to be performed as part of the release letter. We would like to know how many out of this tasks were carried out
One year
Community health services use
Tidsramme: One year
Number of appointments made by the patient during the follow up time for primary physician, professionals, laboratory tests and imaging, physiotherapy and nutritionist.
One year
Evaluation of usability of the technology systems developed
Tidsramme: One year
Using questionnaires for nurses and patients to express their opinion on the use of the technology systems in the project and how much these systems assisted them
One year
Cost-benefits evaluation for the intervention
Tidsramme: One year
Economic evaluation of tests and services saved as a result of active and orderly monitoring of the patient
One year
Assessment of satisfaction of patients from all the projects components (The follow up and the technology systems)
Tidsramme: One year
Using satisfaction questionnaires to be passed at the end of the study
One year
Assessment of satisfaction of medical staff from all the projects components (The follow up and the technology systems)
Tidsramme: One year
Using satisfaction questionnaires to be passed at the end of the study
One year

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Assuta Medical Center

Samarbejdspartnere

European Commission

Efterforskere

  • Studieleder: Bella Azaria, Doctor, Assuta Medical Center

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Hjælpsomme links

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Forventet)

1. februar 2018

Primær færdiggørelse (Forventet)

1. februar 2019

Studieafslutning (Forventet)

1. februar 2019

Datoer for studieregistrering

Først indsendt

23. oktober 2017

Først indsendt, der opfyldte QC-kriterier

26. oktober 2017

Først opslået (Faktiske)

31. oktober 2017

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

31. oktober 2017

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

26. oktober 2017

Sidst verificeret

1. oktober 2017

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 0033-17-ASMC

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ingen

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

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Kliniske forsøg med Kronisk sygdom

Kliniske forsøg med Connecare self managment system

Søg i lignende forsøg

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

CROs by country

CROs in Canada

Betingelser

Sjældne sygdomme

Narkotikainterventioner

Kosttilskud

Sponsor / samarbejdspartnere

Placeringer

Abonner