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A randomised clinical trial on comprehensive geriatric assessment and intensive follow up after hospital discharge: The transitional care bridge.


- candidate number8180
- NTR NumberNTR2384
- ISRCTNISRCTN wordt niet meer aangevraagd.
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR23-jun-2010
- Secondary IDsNL31390.018.10 / 10/082 ; CCMO / MEC
- Public TitleA randomised clinical trial on comprehensive geriatric assessment and intensive follow up after hospital discharge: The transitional care bridge.
- Scientific TitleA randomised clinical trial on comprehensive geriatric assessment and intensive follow up after hospital discharge: The transitional care bridge.
- ACRONYMTransitional care bridge
- hypothesisGeriatric assessment at hospital admission followed by intensive home follow up by a community care nurse will reduce the rate of functional decline six months after admission in acutely hospitalized patients of 65 years and above.
- Healt Condition(s) or Problem(s) studiedMultimorbidity, Internal medicine, Geriatric conditions, Geriatric syndromes
- Inclusion criteria1. Acutely admitted on the department of internal medicine;
2. 65 years and older;
3. Hospitalized for at least 48 hours;
4. At increased risk for functional decline.
- Exclusion criteria1. Terminally ill;
2. No dutch language capabilities;
3. Transferred to the Intensive care unit or other department within 48 hours after admission.
- mec approval receivedyes
- multicenter trialyes
- randomisedyes
- masking/blindingDouble
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-jul-2010
- planned closingdate1-jul-2013
- Target number of participants674
- InterventionsThe intervention group will receive the transitional care bridge program, consisting of a handover moment with a community care nurse (CN) during hospital admission and five home visits after discharge by the CN. The control group will receive ‘care as usual’ after discharge.
- Primary outcomeMain outcome is the level of ADL functioning six months after discharge compared to premorbid functioning measured with the Katz ADL index.
- Secondary outcomeSecondary outcomes include survival, cognitive functioning, quality of life, health care utilization, satisfaction of the patient and primary care giver with the transitional care bridge program.
- TimepointsAll outcomes will be measured at three, six and twelve months after discharge.
- Trial web siteN/A
- statusinclusion stopped: follow-up
- CONTACT FOR PUBLIC QUERIES Bianca Buurman
- CONTACT for SCIENTIFIC QUERIESDr. S.E. Rooij, de
- Sponsor/Initiator Academic Medical Center (AMC), Amsterdam, Onze Lieve Vrouwe Gasthuis (OLVG), Flevo Hospital
- Funding
(Source(s) of Monetary or Material Support)
ZON-MW, The Netherlands Organization for Health Research and Development
- PublicationsN/A
- Brief summaryThis multicenter, double-blind, randomized clinical trial compares a pro-active multi-component nurse-led transitional care program to usual care after discharge. Three hospitals in the Netherlands will participate in the study. All patients ≥ 65 years acutely admitted to the department of internal medicine, hospitalized for at least 48 hours and at risk for functional decline are invited to participate. All patients will receive integrated geriatric care during by a geriatric consultation team during hospital admission. Randomization, which will be stratified by study site and cognitive impairment, will be conducted during admission. The intervention group will receive the transitional care bridge program, consisting of a handover moment with a community care nurse (CN) during hospital admission and five home visits after discharge by the CN. The control group will receive ‘care as usual’ after discharge. Main outcome is the level of ADL functioning six months after discharge compared to premorbid functioning measured with the Katz ADL index. Secondary outcomes include survival, cognitive functioning, quality of life, and health care utilization, satisfaction of the patient and primary care giver with the transitional care bridge program. All outcomes will be measured at three, six and twelve months after discharge. A total of 674 patients will be enrolled and are allocated to the intervention or control group.
- Main changes (audit trail)
- RECORD23-jun-2010 - 23-feb-2015


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