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Help Optimise and Mobilise Elders (H.O.M.E) (HOME)

2022년 8월 1일 업데이트: JurongHealth
During hospitalisations, older inpatients commonly face issues such as immobility, loss of independence, and functional decline. This leads them down the cascade of dependency with consequent increased risk of adverse outcomes, institutionalisation as well as higher post-acute care costs. The investigators hypothesize that by implementing a mobility intervention in the inpatient setting, patients would be able to maintain their function upon discharge and avoid the cascade of dependency. As such, the investigators aim to do this by implementing and evaluating a mobility intervention, while optimising reversible factors affecting mobility among inpatients admitted to a geriatric unit in Singapore. The investigators will also examine the cost impact of a mobility focused model of care and also adopt the effectiveness-implementation hybrid Type 2 design where both effectiveness and implementation spheres are tested simultaneously.

연구 개요

상태

아직 모집하지 않음

정황

개입 / 치료

상세 설명

Aim 1: To examine the effectiveness of multicomponent, mobility-focused model of care in reducing iatrogenic complications and improving patient outcomes. Adopting the Institute for Healthcare Improvement's (IHI) 4Ms framework ("Mobility", "Mentation, "Medication", and "What Matters"), the investigators will examine the effectiveness of timely and individually catered mobility interventions which not only increase mobilization but also optimize factors inhibiting mobility for elderly inpatients. It is hypothesized that the mobility outcomes, such as maximum distance walked and mobilization frequency will be significantly improved for patients who receive the intervention compared to those who receive standard care.

Aim 2: To examine the cost impact of a mobility-focused model of care. The investigators will examine whether the cost of these multicomponent, mobility-focused interventions can be offset from cost savings from early mobilisation benefits, by comparing healthcare utilization costs between-groups. Further to that, a cost effectiveness analysis will be performed should functional effectiveness be observed. For the primary cost impact objective, it is hypothesized that the cost savings arising from reduction in bed days of hospitalization and other medical costs incurred during study period will outweigh the cost of implementing this model of care. In addition, it is also hypothesized that the proposed intervention will be cost-effective through achieving better functional outcomes for patients, with lower costs required.

Aim 3: To evaluate the implementation outcomes of multicomponent, mobility-focused model of care in the process of this intervention. It is hypothesized that this intervention will have good acceptability, feasibility, penetration, implementation costs and sustainability.

연구 유형

중재적

등록 (예상)

90

단계

  • 해당 없음

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 연락처

연구 장소

  • 싱가포르
      • Singapore, 싱가포르, 609606
        • Ng Teng Fong Hospital
        • 연락하다:
        • 부수사관:
          • Seok Mei Lim Dr
        • 부수사관:
          • Dina Ee Dr
        • 부수사관:
          • Weng Kin Lai
        • 부수사관:
          • Russell Yoong
        • 부수사관:
          • Lydia Au Dr
        • 부수사관:
          • Bing Kit Chan
      • Singapore, 싱가포르, 768024
        • Geriatrics Education and Research Institute
        • 연락하다:
        • 부수사관:
          • Tou Nien Xiang Dr
        • 부수사관:
          • Ding Yew Yoong Prof
        • 부수사관:
          • Michelle Jessica Pereira Dr

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

21년 (성인, 고령자)

건강한 자원 봉사자를 받아들입니다

아니

연구 대상 성별

모두

설명

Inclusion Criteria:

  • Newly admitted patients to the geriatric service
  • Aged 75 years and above
  • Mobile with or without the use of a walking aid

Exclusion Criteria:

  • Vancomycin-resistant enterococcus (VRE) status
  • Requires droplet or airborne precautions
  • Critically ill
  • Haemodynamically instability
  • Requires more than 4-hourly parameters
  • Systolic blood pressure <90 mmHg
  • Heart rate >100beats/min
  • Non-ambulant patients
  • With advanced dementia (Functional Assessment Staging Scale [FAST] 7 dementia)
  • Fulfills direct admission to another subspecialty unit

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 방지
  • 할당: 무작위화되지 않음
  • 중재 모델: 병렬 할당
  • 마스킹: 없음(오픈 라벨)

무기와 개입

참가자 그룹 / 팔
개입 / 치료
실험적: Intervention
Intervention group will receive a multicomponent, mobility-focused intervention during the course of inpatient admission.
다른: Multicomponent, mobility-focused intervention
The intervention group will receive early therapist review (within one working day of admission to HOME unit), to be mobilised at least three times a day. They will also receive additional group exercise therapy sessions, as well as nurse screening for geriatric syndromes. Besides that, they will be screened for 4Ms (Mobility, Mentation, Medication, What Matters) by doctor on admission.
간섭 없음: Control
The control group will receive usual care as per current ward practice.

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
Change in maximum distance walked
기간: Upon admission and at the point of discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
The total distance covered by the research participant (in meter)
Upon admission and at the point of discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
Mobilisation frequency
기간: Through the duration of admission
Number of times mobilised. The average mobilisation frequency will be calculated by dividing the sum by the number of admission days.
Through the duration of admission

2차 결과 측정

결과 측정
측정값 설명
기간
Change in modified barthel score
기간: Upon admission, at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay), and one-month post discharge
The score ranges from 0 to 100 with 0 as the worst outcome
Upon admission, at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay), and one-month post discharge
Change in gait speed
기간: Upon admission and at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
4 meter gait speed test (meter/second)
Upon admission and at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
Inpatient length of stay and discharge location
기간: The duration of admission and upon discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
The duration of admission (days) and the location the respective participant is discharged to
The duration of admission and upon discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
Presence of common iatrogenic complications such as delirium, injurious falls, pressure ulcers, and venous thromboembolisms
기간: At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
Each of the complication will be measured in nominal scale; 0 denotes the absence of the complication while 1 denotes the presence of the complications. The total number of complications arise will be calculated. The greater the number indicates poorer outcome
At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
Gross amount of patient's bill during index admission, considering subsidy level
기간: At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
The total gross amount of participant's bill during index admission. The subsidy level will be documented
At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
The intervention related costs for group therapy
기간: At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
The number of group therapy sessions attended by the participant multiply by the cost for one group therapy session. The subsidy level will be documented.
At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)

기타 결과 측정

결과 측정
측정값 설명
기간
Mortality
기간: 1-month follow-up post-discharge
1 denotes survival while 0 denotes the participant passed away
1-month follow-up post-discharge
Readmission
기간: 1-month follow-up post-discharge
The number of readmission due to the index admission within 30 days post discharged
1-month follow-up post-discharge
Healthcare utilisation data and associated costs
기간: 1-month follow-up post-discharge
Number of visits (associated with index admission) to emergency department, specialist outpatient clinic, general practitioner and the associated costs within 30 days post-discharged
1-month follow-up post-discharge
Ambulatory status
기간: 1-month follow-up post-discharge
Self-reported by the participant. Four options: 0 denotes bed-bound, 1 denotes chair-bound, 2 denotes assisted (furniture cruiser, walking frame, rollator frame, quadstick, single point stick); 4 denotes independent
1-month follow-up post-discharge
Fall
기간: 1-month follow-up post-discharge
0 denotes no fall; 1 denotes fall(s) occured (within 30days post-discharged)
1-month follow-up post-discharge
Utilisation of community resources
기간: 1-month follow-up post-discharge
Self-reported by the participant: Five options: 0 denotes home care; 1 denotes day care; 2 denotes meals on wheels; 3 denotes medical escort service; 4 denotes home personal care
1-month follow-up post-discharge

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

JurongHealth

협력자

National Healthcare Group, Singapore
Geriatric Education and Research Institute

수사관

  • 수석 연구원: Melanie Tan Dr, Ng Teng Fong General Hospital
  • 수석 연구원: Lau Lay Khoon Dr, Geriatric Education and Research Institute

간행물 및 유용한 링크

연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.

일반 간행물

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (예상)

2022년 7월 25일

기본 완료 (예상)

2023년 1월 31일

연구 완료 (예상)

2023년 9월 30일

연구 등록 날짜

최초 제출

2022년 6월 25일

QC 기준을 충족하는 최초 제출

2022년 8월 1일

처음 게시됨 (실제)

2022년 8월 2일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2022년 8월 2일

QC 기준을 충족하는 마지막 업데이트 제출

2022년 8월 1일

마지막으로 확인됨

2022년 6월 1일

추가 정보

이 연구와 관련된 용어

키워드

추가 관련 MeSH 약관

기타 연구 ID 번호

  • GERI1627

개별 참가자 데이터(IPD) 계획

개별 참가자 데이터(IPD)를 공유할 계획입니까?

예

IPD 계획 설명

Working together with Geriatric Education and Research Institute and National Healthcare Group (Health Services & Outcomes Research).

IPD 공유 기간

During study period.

IPD 공유 액세스 기준

Via secure platforms (files to be encrypted with password). For the purposes of data sharing and data analysis.

IPD 공유 지원 정보 유형

  • 연구 프로토콜
  • 통계 분석 계획(SAP)
  • 정보에 입각한 동의서(ICF)
  • 임상 연구 보고서(CSR)
  • 분석 코드

약물 및 장치 정보, 연구 문서

미국 FDA 규제 의약품 연구

아니

미국 FDA 규제 기기 제품 연구

아니

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .

이동성 제한에 대한 임상 시험

Multicomponent, mobility-focused intervention에 대한 임상 시험

유사한 임상시험 검색

스폰서 및 공동 작업자

건강 상태

약물 개입

CROs by country

CROs in Papua New Guinea

정황

희귀 질병

약물 개입

식이 보충제

스폰서 / 협력자

위치

구독하다