Treatment of elderly patients in own home – a cross-sectorial alternative to emergency admission

Aim

The purpose of this research project is to avoid cases with unnecessary emergency admissions of elderly, medical patients to reduce the risk of infections, delirium and physical and psychical loss of function at a vulnerable patient group. Moreover, the design of a new cross-sectorial patient pathway in the patient’s own home means fewer emergency admissions, and give the patients a possibility to play a more active role in their own treatment. Hospital treatment in own home is a smaller intervention in the daily life of the patient and is expected to result in increased quality of life.

Methods

By means of action research, practitioners from three municipalities and hospital as well as GPs will in close collaboration in an iterative process, where it is possible to make adjustments in route, find an organizing that can support an optimum treatment in the immediate environment of the citizen. When testing the patient pathway, we develop the pathway further by using patients’ and relatives’ first-hand experiences. The project strives towards a broad evaluation of the new hospital at home patient pathway, and therefore a series of methods such as literature reviews, qualitative interviews, focus groups, participant observations, dialogue meetings, questionnaires, analysis of administrative data and health economics/statistical calculations are used.

Setting

The research project is a joint project between 3 municipalities (Skive, Viborg, Silkeborg), GPs, the ED at Viborg Regional Hospital, Regional Hospital Central Jutland, and the prehospital services.

Population

Inclusion happens when the GP/out-of-hours service and a physician from the ED via a conference call jointly evaluate whether it is suitable for the acute ill patient to be hospital treated in own home. Inclusion criteria: the patient must be 65 years of age or above, live in own home or a nursing home, have been seen by the GP/out-of-hours service in the case of disease in question, and must be able to understand and speak Danish fluently. We expect that 850 patients are treated in own home, while 210 patients will be admitted to the emergency department and included in the control group.

Perspective

The expected output of the research project:

• A new organizing so that more elderly medical patients can be hospital treated in own home

• A reduction of unnecessary emergency admissions

• We identify for which elderly patients it could be a benefit to be treated in own home

• Knowledge about how to and the degree of involvement of elderly in their own treatment

• Due to a broad evaluation (health economics, clinical quality, experienced quality), the research project gives an insight into consequences of moving tasks from region to municipalities

• The action research approach gives a knowledge about how it is possible in municipalities, hospital and medical practice and across layers of organizations to collaborate and take joint responsibility when designing an alternative to emergency admissions

• A base for similar projects and new organization forms for other groups of patients, e.g. younger patients or other vulnerable groups of patients as children

• Insights that can be the base for political decisions concerning prioritizing of further actions concerning treatment in own home

Collaborators

It is a joint research project between 3 municipalities (Skive, Viborg, Silkeborg), GPs, the ED at Viborg Regional Hospital, Regional Hospital Central Jutland, and the prehospital services. Researchers from Department of Management, AU, Research Center for Emergency Medicine, and DEFACTUM support the cross-sectorial collaboration as to knowledge, investigate the process by organizing the new patient pathway across professions, sectors and organization forms, and investigate the effect of the new pathway, both as to quantity and quality. Internationally, Professor David Coghlan from Trinity Business School, Ireland, who is specialized in action research, is affiliated as consultant at the project.