Trial document




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  DRKS00012383

Trial Description

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Title

Needs-Based Provision of Medical Care to Nursing Home Residents

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Trial Acronym

MVP-STAT

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URL of the Trial

[---]*

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Brief Summary in Lay Language

Over 2.6 million people are care-dependent in Germany today, a third of whom live in nursing homes. Many care recipients are in greater need of medical care due to multimorbidity, but restricted cognitive abilities or reduced mobility may give rise to difficulties in consulting their GP or medical specialist or communicating the need to do so. And yet it is of utmost importance that nursing home residents receive individual, needs-based medical care. This is an essential requirement for participation in social activities as well as the preservation and promotion of health and quality of life.
The aim of this project is the investigation of individual needs-based medical care in nursing homes and the development of solutions where medical care is found to be inappropriate. To this end, a sample of 500 nursing home residents in Bremen will be evaluated and, in cooperation with patients, relatives, nursing home and medical staff, a model project will be developed for the improvement of medical care.

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Brief Summary in Scientific Language

Needs-based medical care in nursing homes constitutes a major contribution to the preservation and promotion of health and quality of life in care dependent people. Many care recipients are in greater need of medical care due to multimorbidity, while at the same time limited mobility may impede their access to medical care. As a consequence it may be assumed that provision of medical care in nursing home residents is inappropriate. As previous studies are mainly based on secondary data analysis, they do not provide sufficient information for an evaluation of the appropriateness of medical care in terms of individual needs.
The aim of this project is to gain a better knowledge of needs-based medical care for nursing home residents. In a first step, claims data from the AOK statutory health insurance fund in Bremen/Bremerhaven will be examined to compare and identify differences between medical care provided by GPs and specialists to (i) nursing home residents, (ii) people in need of long-term care who are cared for in a community setting and (iii) patients not requiring long-term care. Any identifiable differences in provision will then be assessed in terms of over and under provision by means of standardised assessment using primary data. Appropriate (or inappropriate) provision of medical care is explained on the basis of qualitative expert interviews as well as case reconstructions. In addition, potential explanatory factors will be analysed statistically by linking statutory health insurance claims data and primary data. In focus group discussions, potentials for improvement and possible solutions are then extrapolated from the findings. Building on this, the Delphi method is then applied to develop and pilot a model project in a nursing home.

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Organizational Data

  •   DRKS00012383
  •   2017/12/06
  •   [---]*
  •   yes
  •   Approved
  •   MVP-STAT, Ethikkommission der Universität Bremen
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Secondary IDs

  • [---]*
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Health Condition or Problem studied

  •   K00-K14 -  Diseases of oral cavity, salivary glands and jaws
  •   H00-H59 -  Diseases of the eye and adnexa
  •   H60-H95 -  Diseases of the ear and mastoid process
  •   G20-G26 -  Extrapyramidal and movement disorders
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Interventions/Observational Groups

  •   We assess health and health care of nursing home residents using standardized function tests and personal interview. Based on the assessed data, a team of physicians evaluates whether study participants obtain appropriate medical care or not. Qualitative interviews with stakeholders and quantitative claims-data analysis are used to identify factors that explain (in)appropriate medical care of nursing home residents.
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Characteristics

  •   Non-interventional
  •   Other
  •   Single arm study
  •   Open (masking not used)
  •   [---]*
  •   Uncontrolled/Single arm
  •   Other
  •   Single (group)
  •   N/A
  •   N/A
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Primary Outcome

The study aims to assess, evaluate and explain whether nursing home residents obtain appropriate medical care or not.

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Secondary Outcome

Primary data (health condition or problem studied):
- Vision assessed by visual test (Bailey Lovie Chart),
- Hearing assessed by whispered voice test,
- Oral health assessed by Oral Health Assessment Tool (OHAT) and Oral Health Impact Profile (OHIP),
- Parkinson's disease assessed by medical chart;

Primary data (general health status):
- Health-related quality of life assessed by 12-Item Short-Form Health Survey (SF-12),
- Depression assessed by Geriatric Depression Scale (GDS) and Cornell Scale for Depression in Dementia (CSDD),
- Functional and cognitive status assessed by Mini Mental State Examination (MMST) and extended Barthel-Index,
- Nutritional status assessed by Mini-Nutritional Assessment Short Form (MNA-SF);

Primary data (medical care):
- Appropriateness of medical care evaluated by GPs and medical specialists for vision, hearing, oral health and Parkinson's disease,
- Causes of (in)appropriate medical care assessed in case reconstructions in case conferences, expert interviews and statistical analysis of linked primary and secondary data
- Potential for improvement identified and pilot project developed by using a modified Delphi method;

Secondary data (medical care):
- medical specialist consultations assessed by claims data,
- drug prescriptions assessed by claims data.

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Countries of Recruitment

  •   Germany
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Locations of Recruitment

  • other 
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Recruitment

  •   Actual
  •   2018/01/08
  •   500
  •   Monocenter trial
  •   National
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Inclusion Criteria

  •   Both, male and female
  •   60   Years
  •   no maximum age
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Additional Inclusion Criteria

Care-dependent people (aged 60 years and over) who are members of the AOK Bremen/Bremerhaven statutory health insurance fund and who are residing for at least 12 months in a nursing home located in the federal state of Bremen and gave informed consent for participation.

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Exclusion Criteria

Participants are excluded if there are any chance findings (i.e. depression, dementia) that substantiate that these participants initially were not capable of giving informed consent.

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Addresses

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    • Universität Bremen, SOCIUM Forschungszentrum Ungleichheit und Sozialpolitik, Abteilung Gesundheit, Pflege und Alterssicherung
    • Mr.  Prof. Dr.  Heinz  Rothgang 
    • Postfach 33 04 40
    • 28334  Bremen
    • Germany
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    • Universität Bremen, Institut für Public Health und Pflegeforschung (IPP)
    • Grazer Straße 4
    • 28359  Bremen
    • Germany
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    • Universität Bremen, Kompetenzzentrum für Klinische Studien Bremen (KKSB)
    • Linzer Straße 4
    • 28359  Bremen
    • Germany
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    • Wissenschaftliches Institut der AOK (WIdO)
    • Rosenthaler Straße 31
    • 10178  Berlin
    • Germany
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    • Universität Bremen, SOCIUM Forschungszentrum Ungleichheit und Sozialpolitik, Abteilung Gesundheit, Pflege und Alterssicherung
    • Ms.  Dr.  Maike  Schulz 
    • Postfach 33 04 40
    • 28334  Bremen
    • Germany
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    • Universität Bremen, SOCIUM Forschungszentrum Ungleichheit und Sozialpolitik, Abteilung Gesundheit, Pflege und Alterssicherung
    • Ms.  Dr.  Maike  Schulz 
    • Postfach 33 04 40
    • 28334  Bremen
    • Germany
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Sources of Monetary or Material Support

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    • Innovationsausschuss beim Gemeinsamen Bundesausschuss
    • Wegelystraße 8
    • 10623  Berlin
    • Germany
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Status

  •   Recruiting complete, follow-up complete
  •   2019/02/28
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Trial Publications, Results and other Documents

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