Sanchez Manuel, Eloy Philippine, Godard Virginie, Coutauchaud Marina, Lenouvel Christine, Charpigny Mathilde, Manchon Pauline, Han Thi Hong Lien, Raynaud-Simon Agathe, Patry Claire
Department of Geriatrics, AP-HP.Nord, Bichat-Beaujon-Bretonneau University Hospitals, Paris, Clichy, France.
AP-HP.Nord, Clinical Investigation Center, Bichat University Hospital, Paris, France.
BMC Geriatr. 2025 May 1;25(1):299. doi: 10.1186/s12877-025-05929-2.
Even when older people are discharged directly home after an emergency department (ED) visit, the risk of deterioration of health status and loss of independence persists. We hypothesize that among older adults discharged from the ED, hospital-community transition care provided by geriatric mobile teams (GMTs) may reduce the early readmission rate and level of disability. Such approaches have rarely been evaluated and cannot be generalized yet. Providing evidence of the positive impact of these strategies may influence public health policies.
We will conduct a national, multicentre, prospective, controlled, quasi-experimental study. All participating centres have an ED and a GMT, some of which provide transitional care. Participants recruited from hospitals where GMT provide transitional care form the "intervention group", whereas participants recruited from hospitals where GMT provide standard in-hospital management are the "control group". Inclusion criteria are age ≥ 75 years, returning to personal home after the ED visit (exclusion of nursing home residents) and having a significant risk for early readmission and/or loss of independence after discharge according to a Triage Risk Screening Tool score ≥ 2. The primary objective of this study is to compare hospital ED readmission rates within 30 days. Among secondary objectives, disability scores at 3 and 6 months will be compared between groups. We estimated that 1322 participants, i.e., 661 per group, is required for the main analysis.
By conducting this study, we aim to provide more evidence of the effectiveness of transitional care on reducing ED readmissions for older adults, and particularly highlight determinants and effects of hospital-community GMT-led interventions. These strategies can be cost-effective while preserving independence and quality of life. We expect that the results will provide a basis to generalize effective strategies to address the challenges of demographic ageing for healthcare systems.
The study protocol was registered on ClinicalTrial.org (ID NCT05814328 Date 20230414).
即使老年人在急诊科就诊后直接出院回家，健康状况恶化和失去独立生活能力的风险依然存在。我们假设，在从急诊科出院的老年人中，老年移动团队（GMTs）提供的医院-社区过渡护理可能会降低早期再入院率和残疾程度。此类方法很少得到评估，目前还无法推广。提供这些策略产生积极影响的证据可能会影响公共卫生政策。
我们将开展一项全国性、多中心、前瞻性、对照、准实验研究。所有参与中心都设有急诊科和老年移动团队，其中一些提供过渡护理。从老年移动团队提供过渡护理的医院招募的参与者构成“干预组”，而从老年移动团队提供标准住院管理的医院招募的参与者为“对照组”。纳入标准为年龄≥75岁、急诊科就诊后返回私人住所（排除养老院居民）且根据分诊风险筛查工具评分≥2，出院后有早期再入院和/或失去独立生活能力的重大风险。本研究的主要目的是比较30天内医院急诊科再入院率。次要目的包括比较两组在3个月和6个月时的残疾评分。我们估计主要分析需要1322名参与者，即每组661名。
通过开展本研究，我们旨在提供更多证据，证明过渡护理对降低老年人急诊科再入院率的有效性，尤其突出以医院-社区老年移动团队为主导的干预措施的决定因素和效果。这些策略在保持独立性和生活质量的同时具有成本效益。我们预计研究结果将为推广有效策略以应对医疗系统人口老龄化挑战提供依据。
该研究方案已在ClinicalTrial.org上注册（ID NCT05814328 日期20230414）。
