Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA): an open-label, stepped-wedge, cluster-randomised controlled trial

Anders Fournaise; Jørgen T Lauridsen; Søren Kabell Nissen; Claire Gudex; Mickael Bech; Anna Mejldal; Uffe Kock Wiil; Jesper Bager Rasmussen; Kristian Kidholm; Lars Erik Matzen; Kurt Espersen; Karen Andersen-Ranberg

doi:10.1016/S2666-7568(23)00023-5

Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA): an open-label, stepped-wedge, cluster-randomised controlled trial

Anders Fournaise, Jørgen T Lauridsen, Søren Kabell Nissen, Claire Gudex, Mickael Bech, Anna Mejldal, Uffe Kock Wiil, Jesper Bager Rasmussen, Kristian Kidholm, Lars Erik Matzen, Kurt Espersen, Karen Andersen-Ranberg

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Abstract

Baggrund
Aldrende befolkninger og mangel på sundhedspersonale fordrer et fokus i primærsektoren på opsporing og forebyggelse af sygdomsforværring og hospitalsindlæggelser blandt ældre hjemmeplejemodtagere. PATINA-algoritmen og beslutningsstøtteværktøjet advarer kommunale sygeplejersker om ældre hjemmeplejemodtagere, der er i risiko for at udvikle et akut indlæggelsesbehov. Formålet med undersøgelsen var at teste, om brugen af PATINA-værktøjet var forbundet med ændringer i brugen af sundhedsydelser.

Metoder
Der blev gennemført et open-label stepped-wedge klynge-randomiseret kontrolleret forsøg i tre danske kommuner, som omfattede 20 hjemmeplejeenheder, der leverede hjemme- og sygepleje til ca. 7000 ældre. Over en periode på 12 måneder blev hjemmeplejeenhederne og deres ældre hjemmeplejemodtagere (65 år eller ældre) tilfældigt udvalgte til interventionsfasen. Det primære undersøgelsesmål var indlæggelse af ældre hjemmeplejemodtagere inden for 30 dage efter at de blev identificerede ved algoritmen. Algoritmen opsporer risiko for indlæggelse. Sekundære undersøgelsesmål var genindlæggelser og andre hospitalskontakter, ambulante kontakter, kontakt med praktiserende læger, midlertidig kommunal aflastning og død inden for 30 dage efter identificering ved algoritmen.

Resultater
I alt deltog 2464 ældre hjemmeplejemodtagere i undersøgelsen: 1216 (49·4%) i kontrolfasen og 1248 (50·6%) i interventionsfasen. I kontrolfasen blev 102 personer indlagt på hospitalet inden for 30 dage med 33 943 dage i risiko (incidens 0·09 pr. 30 dage) sammenlignet med 118 personer med 34 843 dage i risiko (0·10 pr. 30 dage) i interventionsfasen. Interventionen var ikke forbundet med en reduktion i antallet af førstegangsindlæggelser inden for 30 dage (incidensrate-ratio [IRR] 1·10 [90% CI 0·90–1·40]; p=0·28). Desuden var interventionen ikke forbundet med reducerede rater for andre hospitalskontakter (IRR 1·10 [95% CI 0·90–1·40]; p=0·28), ambulante kontakter (1·10 [0·88–1·40]; p=0·42) eller dødelighed (0·82 [0·58–1·20]; p=0·25). Interventionen var forbundet med en reduktion på 59% i genindlæggelsesraten inden for 30 dage efter udskrivelse (IRR 0·41 [95% CI 0·24–0·68]; p=0·0007), en stigning på 140% i kontakter med praktiserende læger (2·40 [1·18–3·20]; p
Fortolkning
På trods af at interventionen ikke havde nogen effekt på det primære undersøgelsesmål, viste PATINA-værktøjet andre fordele for ældre hjemmeplejemodtagere. Algoritmer har potentiale til at flytte brugen af sundhedsydelser fra sekundær- til primærsektoren, men skal testes i andre lande med anden organisering af hjemmepleje. Implementering af algoritmer i klinisk praksis bør baseres på en analyse af omkostningseffektiviteten, potentielle skader samt fordele.

Finansiering
Innovationsfonden og Region Syddanmark.

Copyright © 2023 Forfatteren(e). Udgivet af Elsevier Ltd. Dette er en Open Access-artikel under CC BY-NC-ND

Originalsprog	Engelsk
Tidsskrift	The Lancet Healthy Longevity
Vol/bind	4
Udgave nummer	4
Sider (fra-til)	e132-e142
ISSN	2666-7568
DOI	https://doi.org/10.1016/S2666-7568(23)00023-5
Status	Udgivet - 30. apr. 2023

Dokumenter og links

10.1016/S2666-7568(23)00023-5Licens: CC BY-NC-ND

Open Access VersionForlagets udgivne version, 1,12 MBLicens: CC BY-NC-ND

1 Ph.d.-afhandling

Can timely recognition of deteriorating health prevent hospitalisation of older community-dwelling adults? The effect of a notification algorithm and a digital decision support tool
Bidragets oversatte titel: Kan tidlig opsporing af svigtende helbred forebygge indlæggelse af ældre hjemmeplejemodtagere? : Effekten af en notifikationsalgoritme og et digitalt beslutningsstøtteværktøjFournaise, A., 21. apr. 2023, Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet. 221 s.
Publikation: Afhandling › Ph.d.-afhandling

1 Afsluttet

PATINA: Prevention of acute admIssion algorithm
Fournaise, A. V., Andersen-Ranberg, K., Lauridsen, J. T., Kidholm, K., Bech, M., Espersen, K. & Wiil, U. K.
01/01/2020 → 31/12/2022
Projekter: Projekt › Ph.d-projekt

Citationsformater

Fournaise, A., Lauridsen, J. T., Nissen, S. K., Gudex, C., Bech, M., Mejldal, A., Wiil, U. K., Rasmussen, J. B., Kidholm, K., Matzen, L. E., Espersen, K., & Andersen-Ranberg, K. (2023). Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA): an open-label, stepped-wedge, cluster-randomised controlled trial. The Lancet Healthy Longevity, 4(4), e132-e142. https://doi.org/10.1016/S2666-7568(23)00023-5

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title = "Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA): an open-label, stepped-wedge, cluster-randomised controlled trial",

abstract = "Background: Ageing populations and health-care staff shortages encourage efforts in primary care to recognise and prevent health deterioration and acute hospitalisation in community-dwelling older adults. The PATINA algorithm and decision-support tool alerts home-based-care nurses to older adults at risk of hospitalisation. The study aim was to test whether use of the PATINA tool was associated with changes in health-care use. Methods: An open-label, stepped-wedge, cluster-randomised controlled trial was done in three Danish municipalities, covering 20 area teams providing home-based care to around 7000 recipients. During a period of 12 months, area teams were randomly assigned to an intervention crossover for older adults (aged 65 years or older) who received care at home. The primary outcome was hospitalisation within 30 days of identification by the algorithm as being at risk of hospitalisation. Secondary outcomes were hospital readmission and other hospital contacts, outpatient contacts, contact with primary care physicians (PCPs), temporary care, and death, within 30 days of identification. This study was registered at ClinicalTrials.gov (NTC04398797). Findings: In total, 2464 older adults participated in the study: 1216 (49·4%) in the control phase and 1248 (50·6%) in the intervention phase. In the control phase, 102 individuals were hospitalised within 30 days during 33 943 days of risk (incidence 0·09 per 30 days), compared with 118 individuals within 34 843 days of risk (0·10 per 30 days) during the intervention phase. The intervention was not associated with a reduction in the number of first hospitalisations within 30 days (incidence rate ratio [IRR] 1·10 [90% CI 0·90–1·40]; p=0·28). Furthermore it was not associated with reduced rates of other hospital contacts (IRR 1·10 [95% CI 0·90–1·40]; p=0·28), outpatient contacts (1·10 [0·88–1·40]; p=0·42), or mortality (0·82 [0·58–1·20]; p=0·25). The intervention was associated with a 59% reduction in readmissions within 30 days of hospital discharge (IRR 0·41 [95% CI 0·24–0·68]; p=0·0007), a 140% increase in contacts with PCPs (2·40 [1·18–3·20]; p<0·0001), and a 150% increase in use of temporary care (2·50 [1·40–4·70]; p=0·0027). Interpretation: Despite having no effect on the primary outcome, the PATINA tool showed other benefits for older adults receiving home-based care. Such algorithms have the potential to shift health-care use from secondary to primary care but need to be tested in other home-based care settings. Implementation of algorithms in clinical practice should be informed by analysis of cost-effectiveness and potential harms as well as the benefits. Funding: Innovation Fund Denmark and Region of Southern Denmark. Translations: For the Danish, French and German translations of the abstract see Supplementary Materials section.",

keywords = "Aged, Denmark/epidemiology, Hospitalization, Humans, Independent Living, Patient Discharge, Patient Readmission",

author = "Anders Fournaise and Lauridsen, {J{\o}rgen T} and Nissen, {S{\o}ren Kabell} and Claire Gudex and Mickael Bech and Anna Mejldal and Wiil, {Uffe Kock} and Rasmussen, {Jesper Bager} and Kristian Kidholm and Matzen, {Lars Erik} and Kurt Espersen and Karen Andersen-Ranberg",

year = "2023",

month = apr,

day = "30",

doi = "10.1016/S2666-7568(23)00023-5",

language = "English",

volume = "4",

pages = "e132--e142",

journal = "LANCET HEALTHY LONGEVITY",

issn = "2666-7568",

publisher = "Elsevier Editora",

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Fournaise, A , Lauridsen, JT , Nissen, SK , Gudex, C , Bech, M , Mejldal, A , Wiil, UK, Rasmussen, JB, Kidholm, K, Matzen, LE, Espersen, K & Andersen-Ranberg, K 2023, 'Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA): an open-label, stepped-wedge, cluster-randomised controlled trial', The Lancet Healthy Longevity, bind 4, nr. 4, s. e132-e142. https://doi.org/10.1016/S2666-7568(23)00023-5

Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA) : an open-label, stepped-wedge, cluster-randomised controlled trial. / Fournaise, Anders ; Lauridsen, Jørgen T ; Nissen, Søren Kabell et al.

I: The Lancet Healthy Longevity, Bind 4, Nr. 4, 30.04.2023, s. e132-e142.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA)

T2 - an open-label, stepped-wedge, cluster-randomised controlled trial

AU - Fournaise, Anders

AU - Lauridsen, Jørgen T

AU - Nissen, Søren Kabell

AU - Gudex, Claire

AU - Bech, Mickael

AU - Mejldal, Anna

AU - Wiil, Uffe Kock

AU - Rasmussen, Jesper Bager

AU - Kidholm, Kristian

AU - Matzen, Lars Erik

AU - Espersen, Kurt

AU - Andersen-Ranberg, Karen

PY - 2023/4/30

Y1 - 2023/4/30

N2 - Background: Ageing populations and health-care staff shortages encourage efforts in primary care to recognise and prevent health deterioration and acute hospitalisation in community-dwelling older adults. The PATINA algorithm and decision-support tool alerts home-based-care nurses to older adults at risk of hospitalisation. The study aim was to test whether use of the PATINA tool was associated with changes in health-care use. Methods: An open-label, stepped-wedge, cluster-randomised controlled trial was done in three Danish municipalities, covering 20 area teams providing home-based care to around 7000 recipients. During a period of 12 months, area teams were randomly assigned to an intervention crossover for older adults (aged 65 years or older) who received care at home. The primary outcome was hospitalisation within 30 days of identification by the algorithm as being at risk of hospitalisation. Secondary outcomes were hospital readmission and other hospital contacts, outpatient contacts, contact with primary care physicians (PCPs), temporary care, and death, within 30 days of identification. This study was registered at ClinicalTrials.gov (NTC04398797). Findings: In total, 2464 older adults participated in the study: 1216 (49·4%) in the control phase and 1248 (50·6%) in the intervention phase. In the control phase, 102 individuals were hospitalised within 30 days during 33 943 days of risk (incidence 0·09 per 30 days), compared with 118 individuals within 34 843 days of risk (0·10 per 30 days) during the intervention phase. The intervention was not associated with a reduction in the number of first hospitalisations within 30 days (incidence rate ratio [IRR] 1·10 [90% CI 0·90–1·40]; p=0·28). Furthermore it was not associated with reduced rates of other hospital contacts (IRR 1·10 [95% CI 0·90–1·40]; p=0·28), outpatient contacts (1·10 [0·88–1·40]; p=0·42), or mortality (0·82 [0·58–1·20]; p=0·25). The intervention was associated with a 59% reduction in readmissions within 30 days of hospital discharge (IRR 0·41 [95% CI 0·24–0·68]; p=0·0007), a 140% increase in contacts with PCPs (2·40 [1·18–3·20]; p<0·0001), and a 150% increase in use of temporary care (2·50 [1·40–4·70]; p=0·0027). Interpretation: Despite having no effect on the primary outcome, the PATINA tool showed other benefits for older adults receiving home-based care. Such algorithms have the potential to shift health-care use from secondary to primary care but need to be tested in other home-based care settings. Implementation of algorithms in clinical practice should be informed by analysis of cost-effectiveness and potential harms as well as the benefits. Funding: Innovation Fund Denmark and Region of Southern Denmark. Translations: For the Danish, French and German translations of the abstract see Supplementary Materials section.

AB - Background: Ageing populations and health-care staff shortages encourage efforts in primary care to recognise and prevent health deterioration and acute hospitalisation in community-dwelling older adults. The PATINA algorithm and decision-support tool alerts home-based-care nurses to older adults at risk of hospitalisation. The study aim was to test whether use of the PATINA tool was associated with changes in health-care use. Methods: An open-label, stepped-wedge, cluster-randomised controlled trial was done in three Danish municipalities, covering 20 area teams providing home-based care to around 7000 recipients. During a period of 12 months, area teams were randomly assigned to an intervention crossover for older adults (aged 65 years or older) who received care at home. The primary outcome was hospitalisation within 30 days of identification by the algorithm as being at risk of hospitalisation. Secondary outcomes were hospital readmission and other hospital contacts, outpatient contacts, contact with primary care physicians (PCPs), temporary care, and death, within 30 days of identification. This study was registered at ClinicalTrials.gov (NTC04398797). Findings: In total, 2464 older adults participated in the study: 1216 (49·4%) in the control phase and 1248 (50·6%) in the intervention phase. In the control phase, 102 individuals were hospitalised within 30 days during 33 943 days of risk (incidence 0·09 per 30 days), compared with 118 individuals within 34 843 days of risk (0·10 per 30 days) during the intervention phase. The intervention was not associated with a reduction in the number of first hospitalisations within 30 days (incidence rate ratio [IRR] 1·10 [90% CI 0·90–1·40]; p=0·28). Furthermore it was not associated with reduced rates of other hospital contacts (IRR 1·10 [95% CI 0·90–1·40]; p=0·28), outpatient contacts (1·10 [0·88–1·40]; p=0·42), or mortality (0·82 [0·58–1·20]; p=0·25). The intervention was associated with a 59% reduction in readmissions within 30 days of hospital discharge (IRR 0·41 [95% CI 0·24–0·68]; p=0·0007), a 140% increase in contacts with PCPs (2·40 [1·18–3·20]; p<0·0001), and a 150% increase in use of temporary care (2·50 [1·40–4·70]; p=0·0027). Interpretation: Despite having no effect on the primary outcome, the PATINA tool showed other benefits for older adults receiving home-based care. Such algorithms have the potential to shift health-care use from secondary to primary care but need to be tested in other home-based care settings. Implementation of algorithms in clinical practice should be informed by analysis of cost-effectiveness and potential harms as well as the benefits. Funding: Innovation Fund Denmark and Region of Southern Denmark. Translations: For the Danish, French and German translations of the abstract see Supplementary Materials section.

KW - Aged

KW - Denmark/epidemiology

KW - Hospitalization

KW - Humans

KW - Independent Living

KW - Patient Discharge

KW - Patient Readmission

U2 - 10.1016/S2666-7568(23)00023-5

DO - 10.1016/S2666-7568(23)00023-5

M3 - Journal article

C2 - 37003272

SN - 2666-7568

VL - 4

SP - e132-e142

JO - LANCET HEALTHY LONGEVITY

JF - LANCET HEALTHY LONGEVITY

IS - 4

ER -

Structured decision support to prevent hospitalisations of community-dwelling older adults in Denmark (PATINA): an open-label, stepped-wedge, cluster-randomised controlled trial

Abstract

Dokumenter og links

Fingeraftryk

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Can timely recognition of deteriorating health prevent hospitalisation of older community-dwelling adults? The effect of a notification algorithm and a digital decision support tool

Relaterede Projekter

PATINA: Prevention of acute admIssion algorithm

Citationsformater