Impact of a Health Intervention on Some Indicators in the Care of Chronic Complex Patient (CCP). (CCP)
2017年4月7日 更新者：María José del Olmo Rubio
Impact of a Proactive and Integrated Health Intervention Between Different Assistance Levels Over Some Indicators in the Care of Chronic Complex Patient (CCP)
The aim of this study is to assess the effectiveness of proactive and integrated healthcare program for chronic complex patients (CCP).
This program are based in coordination the primary level of attention with and speciality level.
The objective is reducing hospital readmissions and know the benefit in total cost of care in 4 month before and 4 after intervention.
研究概览
详细说明
Quasi-experimental study with single-arm (pre-post study design without control group). The investigators checking pre and post intervention the effectiveness of a healthcare program for CCP. The interventions consist:
- - Help the nurse in the hospital to carry out the care plans and the continuity care report.
- - Refer patients to the social workers.
- - Collaborate with the social worker to refer to centers of media, long stay and reference hospital.
- - Ensure the follow-up appointments for the CCP.
- - Make proactive calls to the CCP and/or their caregiver after discharge
- - Plan the hospital discharge 48 hours in advance, so that the family and the patient can be organized.
The investigator analysed if with this program, the CCP reducing hospital readmission and reducing the Hospital expenditure.
研究类型
介入性
注册 (实际的)
28
阶段
- 不适用
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习地点
-
-
-
Madrid、西班牙、28041
- Hospital Universitario 12 de Octubre de Madrid
-
-
参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
75年 及以上 (年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
Inclusion Criteria:
- Patient ≥ 75 years.
- Having attended 5 or more emergency visits or having had more than 3 hospital admissions in the last 12 months.
- Identified with social risk alert.
Exclusion Criteria:
- Participate in other health programs (AHT, diabetes mellitus,...).
- Terminal patient.
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
- 主要用途：预防
- 分配：不适用
- 介入模型：单组作业
- 屏蔽：无（打开标签）
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
其他：Proactive healthcare intervention
Participants who were included before (single-arm pre-post study), now a proactive and integrated intervention program for the health is performed of the complex chronic patient, based in an improvement of the care process.
|
There is an intervention in the coordination of health resources, and monitoring readmissions and know the benefit in total cost of care in 4 month.
|
研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Pre-post change in days of Hospital stay from baseline to 16 weeks.
大体时间：Baseline and 16 weeks.
|
The same group of patients are analyzed the days of hospital stay at the end of 16 weeks of follow-up pre intervention (baseline) and 16 week after the intervention.
|
Baseline and 16 weeks.
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Number of hospital readmissions visits for CCP change from baseline to 16 weeks.
大体时间：Baseline and 16 weeks.
|
The same group of patients are analyzed the number of hospital readmissions visit for CCP at the end of 16 weeks pre intervention (considered baseline) of follow-up and 16 weeks after the intervention.
|
Baseline and 16 weeks.
|
|
Number of urgency visits for CCP change from baseline to 16 weeks.
大体时间：Baseline and 16 weeks.
|
The same group of patients are analyzed the number of urgency visits and primary care visit for CCP at the end of 16 weeks pre intervention (considered baseline) of follow-up and 16 weeks after the intervention.
|
Baseline and 16 weeks.
|
|
Number of primary care visits for CCP change from baseline to 16 weeks.
大体时间：Baseline and 16 weeks.
|
The same group of patients are analyzed the number of primary care visits for CCP at the end of 16 weeks pre intervention (considered baseline) of follow-up and 16 weeks after the intervention.
|
Baseline and 16 weeks.
|
合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 首席研究员：María José del Olmo Rubio、Hospital 12 de Octubre de Madrid
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始
2015年7月1日
初级完成 (实际的)
2016年7月1日
研究完成 (实际的)
2017年1月1日
研究注册日期
首次提交
2017年3月16日
首先提交符合 QC 标准的
2017年3月21日
首次发布 (实际的)
2017年3月27日
研究记录更新
最后更新发布 (实际的)
2017年4月10日
上次提交的符合 QC 标准的更新
2017年4月7日
最后验证
2017年4月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.
预防保健的临床试验
-
Washington University School of MedicineColumbia University; Indiana University; Rakai Health Sciences Program; Reach the Youth Uganda主动，不招人
Proactive healthcare intervention的临床试验
-
University of Wisconsin, MadisonNational Cancer Institute (NCI); Northwestern University主动，不招人
-
University of Illinois at ChicagoShirley Ryan AbilityLab; Oakland University; Access Living主动，不招人