Vårdkedja: från akutmottagning till eget boende A continuum of care for frail elderly people ext0134-1-1 Swedish National Data Service Svensk nationell datatjänst http://www.biomedcentral.com/1471-2318/13/76 http://www.biomedcentral.com/1471-2318/11/24 http://www.pagepressjournals.org/index.php/hpr/article/view/1515 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601533/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236306/ Vårdkedja: från akutmottagning till eget boende A continuum of care for frail elderly people ext0134-1-1 Wilhelmson, Katarina Wilhelmson, Katarina Dahlin-Ivanoff, Synneve Dahlin-Ivanoff, Synneve Swedish National Data Service Svensk nationell datatjänst http://www.biomedcentral.com/1471-2318/13/76 http://www.biomedcentral.com/1471-2318/11/24 http://www.pagepressjournals.org/index.php/hpr/article/view/1515 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601533/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236306/ Aged Äldre Rehabilitation Rehabilitering Activities of Daily Living Aktiviteter i dagliga livet Aged, 80 and over Äldre, 80 och över Frail Elderly Sköra äldre Geriatrics Geriatrik Nursing Care Omvårdnad Geriatric Nursing Äldrevård Signs and Symptoms Tecken och symtom Exercise Träning Surveys and Questionnaires Kartläggning och enkäter Case-Control Studies Fall-kontrollstudier Cognition Kognition Registries Register Disease Sjukdom Hospitalization Sjukhusvistelse Social Support Socialt stöd Fatigue Trötthet Weight Loss Viktminskning HEALTH SERVICES HÄLSOVÅRD HEALTH HÄLSA The intervention “A continuum of care for frail elderly people” takes place in the municipality of Mölndal, Sweden, including municipal health and social care, the hospital of Mölndal, and primary care. The study has a descriptive analytical and experimental design. The intervention is performed as a randomised controlled trial. The participants were randomised to two study arms, one intervention group and one control group. Intervention group: The intervention includes an early geriatric assessment, early family support, a case manager in the community with a multi-professional team and the involvement of the elderly people and their relatives in the planning process. Control group: The control group received conventional care and follow up. The study group included 161 elderly people who sought care at the emergency department at Mölndal Hospital during the period October 2008 to June 2010 and who were discharged to their own homes in the municipality of Mölndal. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one activity of daily living. A baseline interview and assessment were done within a week of discharge. In some cases it was not possible to do the baseline interview so soon, mostly because the frail elderly person not having enough strength. Follow up data were collected at 3, 6 and 12 months, and after 2 years following the baseline measurement. Purpose: The overall aim of the study was to implement the intervention and thereby create a continuum of care for frail elderly people, from the emergency ward to their own homes, resulting in a better quality of care and higher cost-effectiveness. Another aim was to study the implementation process of the intervention programme. The dataset includes the participants in the intervention group and the control group, a total of 161 participants. The baseline intervention was carried out between October 2008 and June 2010, and follow ups at 3, 6 and 12 months. Interventionen ”Vårdkedja: från akutmottagning till eget boende" bedrivs inom Mölndals kommun, och inkluderar den kommunala vård- och omsorgen, sjukhus, samt primärvård. Studien hade en deskriptiv, analytisk och experimentell design. Interventionen genomfördes som en randomiserad kontrollerad studie där deltagarna randomiserades till interventions- eller kontrollgrupp. Interventionsgrupp: Interventionen omfattade en tidig geriatrisk bedömning, tidigt familjestöd, en kontaktsköterska med ett multiprofessionellt team och medverkan av den äldre och de anhöriga vid planeringsprocessen. Kontrollgrupp: Kontrollgruppen fick traditionell vård och uppföljning. Studiegruppen inkluderade 161 äldre personer som sökte vård på akutmottagningen på Mölndals sjukhus under perioden oktober 2008 till juni 2010 och som skrevs ut till sina egna hem i Mölndals kommun. En baslinjeintervju och bedömning gjordes inom en vecka efter utskrivningen. I vissa fall var det inte möjligt att göra baslinjeintervjun så snart, främst för att den sårbara äldre personen inte hade tillräckligt med styrka. Uppföljande datainsamling skedde vid 3, 6 och 12 månader, samt 2 år efter baslinjemätningen. Syfte: Projektet syftar till att skapa en sammanhållen vårdkedja för äldre sårbara personer, från akutmottagning ut i det egna hemmet, och därmed ett bättre omhändertagande med ökad vårdkvalitet för den enskilde och ökad kostnadseffektivitet för samhället. Datasetet innefattar deltagarna i interventionsgruppen och kontrollgruppen, totalt 161 personer. Interventionens baslinjemätning genomfördes mellan oktober 2008 och juni 2010 och därefter skedde uppföljning vid 3, 6 och 12 månader. 2008-10 2011-07 2008-10 2011-07 2008-10 2011-07 The population is based on elderly people who sought care at the emergency department at Mölndal Hospital during the period October 2008 to June 2010 and who were discharged to their own homes in the municipality of Mölndal. Populationen baseras på äldre personer som sökt vård på akutmottagningen på Mölndals sjukhus under perioden oktober 2008 till juni 2010, och som blivit utskrivna till sina egna hem inom Mölndals kommun. Numeric The participants were recruited at the emergency wards at Mölndal Hospital. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one activity of daily living. Exclusion criteria were acute severe illness with immediate need of assessment and treatment by a physician (within ten minutes), dementia (or severe cognitive impairment), and palliative care. The nurse with geriatric competence screened most of the patients during her work shift to see if they fulfilled the inclusion criteria. If so, the nurse informed about the study both verbally and in writing. The information included a description of the study, how it would be conducted and what was expected of people who agreed to participate. There were opportunities to ask questions if anything was unclear. It was stressed, both in the verbal and the written information that participation was voluntarily. Of all those invited to participate, 17 were invited by letter, as they had been discharged before the nurse was able to ask them. People who accepted to participate in the study were randomised to intervention or control by using a system of sealed opaque envelopes. All participants signed a written consent form. The study started with a pilot study to test intervention, inclusion/exclusion criteria and logistics. The pilot study comprised the first ten included participants.The participants were recruited at the emergency wards at Mölndal Hospital. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one activity of daily living. Exclusion criteria were acute severe illness with immediate need of assessment and treatment by a physician (within ten minutes), dementia (or severe cognitive impairment), and palliative care. The nurse with geriatric competence screened most of the patients during her work shift to see if they fulfilled the inclusion criteria. If so, the nurse informed about the study both verbally and in writing. The information included a description of the study, how it would be conducted and what was expected of people who agreed to participate. There were opportunities to ask questions if anything was unclear. It was stressed, both in the verbal and the written information that participation was voluntarily. Of all those invited to participate, 17 were invited by letter, as they had been discharged before the nurse was able to ask them. People who accepted to participate in the study were randomised to intervention or control by using a system of sealed opaque envelopes. All participants signed a written consent form. The study started with a pilot study to test intervention, inclusion/exclusion criteria and logistics. The pilot study comprised the first ten included participants. Studiens deltagare rekryterades vid akutavdelningar på Mölndals sjukhus. Inklusionskriterier var 80 år och äldre, eller personer mellan 65-79 år med minst en kronisk sjukdom samt beroende av minst en aktivitet i det dagliga livet. Exklusionskriterier var akut svår sjukdom med omedelbart behov av bedömning och behandling av läkare (inom tio minuter), demens (eller svår kognitiv svikt) och palliativ vård. En sjuksköterska med geriatrisk kompetens screenade de flesta av patienterna under hennes arbetspass för att se om de uppfyllde inklusionskriterierna. Om så var fallet informerade sköterskan, såväl skriftligt som muntligt, om studien. Informationen innehöll en beskrivning av studien, hur den skulle genomföras och vad som förväntades av dem som ville delta. Det fanns även möjlighet att ställa frågor. Det betonades att deltagandet i studien var helt frivilligt. Av alla som bjöds in att delta var 17 inbjudna per brev, då dessa redan hunnit skrivas ut innan sjuksköterskan hann fråga dem. De som valde att delta i studien randomiserades till intervention eller kontroll, med hjälp av ett system med ogenomskinliga kuvert. Alla deltagare undertecknade en skriftlig medgivande. Studien inleddes med en pilotstudie som inkluderade de första tio deltagarna.Studiens deltagare rekryterades vid akutavdelningar på Mölndals sjukhus. Inklusionskriterier var 80 år och äldre, eller personer mellan 65-79 år med minst en kronisk sjukdom samt beroende av minst en aktivitet i det dagliga livet. Exklusionskriterier var akut svår sjukdom med omedelbart behov av bedömning och behandling av läkare (inom tio minuter), demens (eller svår kognitiv svikt) och palliativ vård. En sjuksköterska med geriatrisk kompetens screenade de flesta av patienterna under hennes arbetspass för att se om de uppfyllde inklusionskriterierna. Om så var fallet informerade sköterskan, såväl skriftligt som muntligt, om studien. Informationen innehöll en beskrivning av studien, hur den skulle genomföras och vad som förväntades av dem som ville delta. Det fanns även möjlighet att ställa frågor. Det betonades att deltagandet i studien var helt frivilligt. Av alla som bjöds in att delta var 17 inbjudna per brev, då dessa redan hunnit skrivas ut innan sjuksköterskan hann fråga dem. De som valde att delta i studien randomiserades till intervention eller kontroll, med hjälp av ett system med ogenomskinliga kuvert. Alla deltagare undertecknade en skriftlig medgivande. Studien inleddes med en pilotstudie som inkluderade de första tio deltagarna. ProbabilityProbability SannolikhetsurvalSannolikhetsurval Physical measurements and testsPhysical measurements and tests Fysiska mätningar och testerFysiska mätningar och tester Face-to-face interviewFace-to-face interview Personlig intervjuPersonlig intervju ObservationObservation ObservationObservation Access to data through an external actor. Access to data is restricted. Åtkomst till data via extern aktör. Tillgång till data är begränsad. restrictedAccess Eklund K, Wilhelmson K, Gustafsson H, Landahl S, Dahlin-Ivanoff S. One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial: "Continuum of care for frail older people". BMC Geriatr. 2013 Jul 22;13:76. doi: 10.1186/1471-2318-13-76. Eklund K, Wilhelmson K, Gustafsson H, Landahl S, Dahlin-Ivanoff S. One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial: "Continuum of care for frail older people". 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