- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT02211274
VA Community Living Centers to Home
Improving Veteran Transitions From VA Community Living Centers to the Community
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
Up to 29% of Community Living Center (CLC; VA nursing homes) residents may not require nursing home levels of care and could successfully reside in the community with appropriate rehabilitative services. Many older adults prefer to remain in their homes, though living independently in the community is not always possible or safe. According to the model of person-environment fit (P-E fit), older adults are at risk for poor outcomes when the demands and resources available in the living environment are not in balance with the individual's everyday competence (the ability to solve problems associated with everyday life). Community-dwelling older adults with low levels of everyday competence and little support are at risk for nursing home transition. Conversely, older adults with higher levels of everyday competence who live in more restrictive environments (e.g., nursing home) may experience declines in functioning resulting from a lack of stimulation. Often, transitions into nursing homes occur during a time of crisis (e.g., after acute hospital stay), leaving little opportunity for appropriate consideration of the individual's current and future level of everyday competence.
In VA, a major focus is to minimize the time spent in the CLCs by providing rehabilitation services and transitioning Veterans back into the community. The mission for the CLC program is to return the Veteran to his or her highest level of well-being, thus maximizing P-E fit. Despite this, CLC staff and Veterans face many barriers to facilitating transitions to the community (e.g., caregiving needs, housing, etc.). Currently no standardized process exists to assure that treatment planning includes processes to maximize P-E fit (e.g., assessing everyday competence, setting resident-directed goals around rehabilitation needs, and developing care plans to transition the Veteran to the community whenever possible).
The investigators' team has developed an instrument to allow providers to assess everyday competence for safe and independent living in the community. However, to ensure successful transitions, assessing everyday competence without intervention is not sufficient. Once CLC interdisciplinary team members have an understanding of the resident's everyday competence and barriers to transition, goal-setting must occur, focused on rehabilitation goals and care planning around transitioning to the community.
The objective of the proposed research is to develop an effective and feasible toolkit the CLC interdisciplinary team can use to 1) assess the Veteran's everyday competence for safe and independent living; 2) develop personally meaningful rehabilitation goals that facilitate successful transition out of the CLC based on everyday competence; and 3) conduct structured care planning to support resident goals around transitioning back into the community. With the innovative consideration of everyday competence and goal-setting in this context, Veterans will have optimal P-E fit upon returning to the community, thus ensuring a successful transition outcome (i.e., not readmitted to the CLC within 90 days).
Studietype
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiesteder
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Rhode Island
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Providence, Rhode Island, Forente stater, 02908
- Providence VA Medical Center, Providence, RI
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Texas
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Houston, Texas, Forente stater, 77030
- Michael E. DeBakey VA Medical Center, Houston, TX
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-
Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- CLC residents will be included if they are able to demonstrate understanding of the informed consent process through teach-back and to communicate verbally.
Exclusion Criteria:
- CLC residents will be excluded if they are too cognitively impaired or have serious mental illness too severe to meaningfully participate in interviews (i.e., they are not "transition-capable").
- No participants will be excluded based on gender, race, social class, or ethnicity.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Helsetjenesteforskning
- Tildeling: N/A
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Eksperimentell: Study Group
Individuals who want to leave the CLC will be allowed to participate in the study, there will be no assignment to groups.
Individuals who want to leave the CLC will undergo transition care planning using the investigators' standardized toolkit.
The investigators will compare outcomes to administrative data from other similar VA nursing homes.
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The Everyday Competence Assessment and Planning for Community Transitions (ECAP-CT) toolkit will allow CLC interdisciplinary team members to 1) assess the Veteran's everyday competence for safe and independent living; 2) develop personally meaningful rehabilitation goals that facilitate successful transition out of the CLC based on everyday competence; and 3) conduct structured treatment planning to support resident goals around transitioning back into the community.
By considering everyday competence and goal-setting in this context, Veterans will have optimal P-E fit upon returning to the community, ensuring a successful transition.
Andre navn:
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Transition Outcome
Tidsramme: 90 days post-discharge
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The primary outcome of interest for this pilot study will be transition outcome.
Transitions will be "successful" if the resident leaves the CLC with a "community" destination and is not readmitted to the CLC within 90 days.
For the purposes of this study, transitions to the "community" include any non-institutional environment that is more independent than the CLCs (e.g., single-family home, senior apartment, assisted living, medical foster home, etc.).
For individuals who are unable to transition or who transition and are readmitted to the CLC within 90 days, these transitions will be "unsuccessful".
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90 days post-discharge
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Goal Attainment Scaling
Tidsramme: Baseline
|
An important outcome for participants at the intervention sites will be Goal Attainment Scaling64, which will allow us to identify if the resident was able to achieve the transition goals within the planned timeframe.
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Baseline
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Multilevel Assessment Instrument - Environment Scale [MAI-ES]
Tidsramme: Baseline and 90 days
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Measures person-environment fit
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Baseline and 90 days
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Multilevel Assessment Instrument - Environment Scale [MAI-ES]
Tidsramme: 90 days
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Measures person-environment fit.
Will be assessed at baseline and 90 days.
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90 days
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Multilevel Assessment Instrument - Environment Scale
Tidsramme: Baseline and 90 days post discharge
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Measures person-environment fit.
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Baseline and 90 days post discharge
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Money Follows the Person - Quality of Life Scale
Tidsramme: Baseline and 90 days post discharge
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Measures quality of life for individuals moving from a nursing home to the community.
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Baseline and 90 days post discharge
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Care Transitions Measure - 3
Tidsramme: Baseline and 90 days post discharge
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Measures individual's preparation for transitioning out of a health care facility.
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Baseline and 90 days post discharge
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Geriatric Depression Scale - Residential
Tidsramme: Baseline and 90 days post discharge
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Measure of depression for older adults residing in residential care facilities.
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Baseline and 90 days post discharge
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Length of Stay in CLC
Tidsramme: 30 days and 90 days post discharge
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Length of stay in the clc
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30 days and 90 days post discharge
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Health Services Utilization
Tidsramme: 30 days and 90 days post discharge
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Identify health services (e.g., hospital admission, ER visit, etc.) utilization following transition from CLC.
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30 days and 90 days post discharge
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Samarbeidspartnere og etterforskere
Etterforskere
- Hovedetterforsker: Whitney L. Mills, PhD, Providence VA Medical Center, Providence, RI
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Anslag)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Andre studie-ID-numre
- D1241-W
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