Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Emilia-Romagna, Italy.
Research and Innovation Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Emilia-Romagna, Italy.
BMJ Open. 2020 Feb 17;10(2):e034742. doi: 10.1136/bmjopen-2019-034742.
Nursing home residents represent a particularly vulnerable population experiencing high risk of unplanned hospital admissions, but few interventions have proved effective in reducing this risk. The aim of this research will be to verify the effects of a hospital-based multidisciplinary mobile unit (MMU) team intervention delivering urgent care to nursing home residents directly at their bedside.
Four nursing homes based in the Parma province, in Northern Italy, will be involved in this prospective, pragmatic, multicentre, 18-month quasiexperimental study (sequential design with two cohorts). The residents of two nursing homes will receive the MMU team care intervention. In case of urgent care needs, the nursing home physician will contact the hospital physician responsible for the MMU team by phone. The case will be triaged as (a) manageable by phone advice, (b) requiring urgent assessment by the MMU team or (c) requiring immediate emergency department (ED) referral. MMU team is composed of one senior physician and one emergency-medicine resident chosen within the staff of Internal Medicine and Critical Subacute Care Unit of Parma University-Hospital, usually with different specialty background, and equipped with portable ultrasound, set of drugs and devices useful in urgency. The MMU visits patients in nursing homes, with the mission to stabilise clinical conditions and avoid hospital admission. Residents of the other two nursing homes will receive usual care, that is, ED referral in every case of urgency. Study endpoints include unplanned hospital admissions (primary), crude all-cause mortality, hospital mortality, length of stay and healthcare-related costs (secondary).
The study protocol was approved by the Ethics Committee of Area Vasta Emilia Nord (Emilia-Romagna region). Informed consent will be collected from patients or legal representatives. The results will be actively disseminated through peer-reviewed journals and conference presentations, in compliance with the Italian law.
ClinicalTrials.gov Registry (NCT04085679); Pre-results.
养老院居民是一个特别脆弱的群体，他们有很高的非计划性住院风险，但很少有干预措施被证明能有效降低这种风险。本研究旨在验证基于医院的多学科移动单位 (MMU) 团队干预措施的效果，该措施直接在养老院居民床边为他们提供紧急护理。
这项前瞻性、实用、多中心、为期 18 个月的准实验研究（顺序设计，有两个队列）将涉及意大利北部帕尔马省的 4 家养老院。两家养老院的居民将接受 MMU 团队护理干预。如果有紧急护理需求，养老院医生将通过电话联系负责 MMU 团队的医院医生。该病例将被分诊为 (a) 通过电话咨询即可处理，(b) 需要 MMU 团队紧急评估，或 (c) 需要立即转急诊部 (ED)。MMU 团队由一名高级医生和一名选择自帕尔马大学医院内科和危重病亚急性护理科的急诊医学住院医师组成，通常具有不同的专业背景，并配备便携式超声仪、一套药物和在紧急情况下有用的设备。MMU 会到养老院访问患者，其使命是稳定临床状况并避免住院。另外两家养老院的居民将接受常规护理，即任何紧急情况下都转至 ED。研究终点包括非计划性住院（主要终点）、粗全因死亡率、医院死亡率、住院时间和医疗保健相关费用（次要终点）。
该研究方案已获得艾米利亚-罗马涅地区瓦塔埃米利亚诺-北地区伦理委员会的批准。将从患者或法定代表处收集知情同意书。结果将按照意大利法律，通过同行评议期刊和会议报告积极传播。
ClinicalTrials.gov 注册 (NCT04085679)；预结果。
