Supporting older people with cognitive impairment during and after hospital stays with intersectoral care management (intersec-CM)—results of a randomised clinical trial
Background
The transition from hospital to primary care is a risk factor for negative health outcomes in people with cognitive impairment.
Objective
To test the effectiveness of intersectoral care management during the transition from hospital to primary care on repeated admission to hospital, functionality and institutionalisation in people with cognitive impairment.
Design
Longitudinal multisite randomised controlled trial with two arms (care as usual and intersectoral care management) and two follow-ups 3 and 12 months after discharge.
Setting
Three hospitals in two different primary care regions in Germany.
Subjects
n = 401 people with cognitive impairment: community-dwelling, age 70+. Randomised into control (n = 192) or intervention (n = 209).
Methods
Primary outcomes for the study after 3 months: admission to hospital, physical and instrumental functionality. Primary outcome after 12 months: institutionalisation, physical and instrumental functionality. Secondary outcomes: health-related quality of life, depressive symptoms, cognitive status and frailty. Statistical analyses include descriptive analyses as well as univariate and multivariate regression models for all outcomes.
Results
There was no statistically significant effect of the intervention on hospital admission and activities of daily living after 3 months, as well as on institutionalisation and activities of daily living after 12 months. There were significantly fewer participants in the intervention group readmitted to the hospital 12 months after discharge.
Analyses show a significant effect on health-related quality of life 3 months and 12 months after discharge. Depressive symptoms were significantly less likely in the intervention group 3 months after discharge. No effects on cognition or frailty.
Conclusion
Intersectoral care management supports people with cognitive impairment during discharge and transition. Even though we were not able to show an impact of the intervention on the chosen primary outcomes everyday functionality and institutionalisation, the effects on health-related quality of life, hospital admission rate and mental health are solid indicators for an improved individual situation.
Trial registration
ClinicalTrials.gov, NCT03359408; https://clinicaltrials.gov/ct2/show/NCT03359408
