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

1 augustus 2022 bijgewerkt door: 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.

Studie Overzicht

Toestand

Nog niet aan het werven

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

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.

Studietype

Ingrijpend

Inschrijving (Verwacht)

90

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Studie Locaties

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

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

21 jaar tot 110 jaar (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

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

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Preventie
  • Toewijzing: Niet-gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Intervention
Intervention group will receive a multicomponent, mobility-focused intervention during the course of inpatient admission.
Ander: 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.
Geen tussenkomst: Control
The control group will receive usual care as per current ward practice.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Change in maximum distance walked
Tijdsspanne: 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
Tijdsspanne: 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

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Change in modified barthel score
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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)

Andere uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Mortality
Tijdsspanne: 1-month follow-up post-discharge
1 denotes survival while 0 denotes the participant passed away
1-month follow-up post-discharge
Readmission
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

JurongHealth

Medewerkers

National Healthcare Group, Singapore
Geriatric Education and Research Institute

Onderzoekers

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

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Verwacht)

25 juli 2022

Primaire voltooiing (Verwacht)

31 januari 2023

Studie voltooiing (Verwacht)

30 september 2023

Studieregistratiedata

Eerst ingediend

25 juni 2022

Eerst ingediend dat voldeed aan de QC-criteria

1 augustus 2022

Eerst geplaatst (Werkelijk)

2 augustus 2022

Updates van studierecords

Laatste update geplaatst (Werkelijk)

2 augustus 2022

Laatste update ingediend die voldeed aan QC-criteria

1 augustus 2022

Laatst geverifieerd

1 juni 2022

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • GERI1627

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

Ja

Beschrijving IPD-plan

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

IPD-tijdsbestek voor delen

During study period.

IPD-toegangscriteria voor delen

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

IPD delen Ondersteunend informatietype

  • Leerprotocool
  • Statistisch Analyse Plan (SAP)
  • Formulier voor geïnformeerde toestemming (ICF)
  • Klinisch onderzoeksrapport (CSR)
  • Analytische code

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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