Trial document




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  DRKS00013161

Trial Description

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Title

Study "WOHIN":
Decision path for discharge planning in patients with dementia as secondary diagnosis in the acute hospital: back to one's own home or move to a care facility?

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Trial Acronym

Wohin

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URL of the Trial

https://www.bosch-stiftung.de/de/projekt/menschen-mit-demenz-im-akutkrankenhaus/gefoerderte-projekte

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Brief Summary in Lay Language

Together with the DZNE German Center for Neurodegenerative Diseases Magdeburg, the University Hospital Magdeburg A. ö. R. is currently conducting a study on where patients with dementia are discharged from the hospital.

The decision, where a patient is discharged (back home or transfer in a care facility), must be made in hospitals. For patients with dementia it is important that this decision is well prepared and properly taken.


The clinic is investigating the decision-making process and intends to improve it by introducing a standardized assessment. The decision should be taken as best as possible, taking into account all information.

Both before and after the introduction of the assessment surveys will take place.

To monitor, how the decision is made, the patient (if possible), the relatives / legal guardians and the treatment team, that means for example the doctors, nurses, therapists and social workers, will be questioned. Medical documentation is also included.

The relatives / legal guardians are contacted regularly after the discharge by telephone and asked about the condition of the patient and the satisfaction with the living situation.

After the introduction of the assessment, the results of the survey are expected to produce better results in the patient. It is assumed that patients are more self-sufficient, have fewer symptoms, are more rarely hospitalized, are less likely to die and are more satisfied with their decision to live.

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Brief Summary in Scientific Language

Main study: The study "WOHIN" focuses on the standardization of the decision, where patients from acute hospitals, who have dementia as secondary diagnosis and who have been living in their own home in a pre-hospitalized setting, are poststationarily discharged.

Background: Acute hospitals are often the decision-making place for patients with dementia.

What is done: First, the usual procedure of the decision, where the patient is discharged, is to be collected in four clinics of the university hospital Magdeburg A. ö. R. This should be done by taking the medical documentation and by means of patient-related interviews with the clinical staff and (if possible) the patient himself and their relatives / legal guardians shortly before discharge.

On this basis, a decision-making path is then developed and implemented in the clinics. This path also includes a standardized assessment of the decision-making capacity of patients with dementia.

Initial experiences with the path should be systematically checked. For this purpose, a two-phase follow-up is carried out in the control and intervention group design (before and after the implementation of the path), in which relatives / legal guardians of patients are questioned at intervals even after discharge.

Study participants: Study participants are patients, who have dementia as secondary diagnosis and who have been living in their own home in a pre-hospitalized setting.

Objectives: The aim is to ensure that the decision is taken as best as possible, taking all information into account. The quality of decisions is to be improved.

Hypotheses: In contrast to the control group, significantly better outcomes are expected in the intervention group for the criteria of self-employment, neuropsychiatric symptoms, rehospitalisation, mortality and satisfaction with the final decision on the place of residence after the discharge and the housing situation in the course.

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Organizational Data

  •   DRKS00013161
  •   2017/10/26
  •   [---]*
  •   yes
  •   Approved
  •   88/17, Ethikkommission der Medizinischen Fakultät der Otto-von-Guericke-Universität Magdeburg
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Secondary IDs

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Health Condition or Problem studied

  •   dementia (ICD-10 F00-F03)
  •   F00 -  Dementia in Alzheimer disease
  •   F01 -  Vascular dementia
  •   F02 -  Dementia in other diseases classified elsewhere
  •   F03 -  Unspecified dementia
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Interventions/Observational Groups

  •   Patients with dementia as secondary diagnosis in the acute hospital, which still resides at home, are accompanied before implementation of a decision path during and after their discharge. Patients (if possible), their relatives / legal guardians and clinicians (doctors, nursing staff, social services, therapists) are interviewed with semi-standardized interviews shortly before discharge. The collected medical documentation of the patient is statistical analyzed with regard to any predictors. The follow-up survey is conducted with the patient's relatives by means of semi-standardized interviews shortly after discharge and at 3-monthly intervals by telephone.
  •   Patients with dementia as secondary diagnosis in the acute hospital, which still resides at home, are accompanied after implementation of a decision path during and after their discharge. Patients (if possible), their relatives / legal guardians and clinicians (doctors, nursing staff, social services, therapists) are interviewed with semi-standardized interviews shortly before discharge. The collected medical documentation of the patient is statistical analyzed with regard to any predictors. The follow-up survey is conducted with the patient's relatives by means of semi-standardized interviews shortly after discharge and at 3-monthly intervals by telephone.
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Characteristics

  •   Interventional
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  •   Non-randomized controlled trial
  •   Open (masking not used)
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  •   Control group receives no treatment
  •   Other
  •   Other
  •   N/A
  •   N/A
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Primary Outcome

To show the procedure of the decision, where a patient with dementia as a secondary diagnosis is discharged; analysis of predictors, which lead to the decision to discharge

shortly before the patient is discharged;

semi-standardized interviews with clinicians (doctors, nursing staff, social services, therapists), patients themselves (if possible) and their relatives / legal guardians; interview guide redesigned on the researcher's side

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Secondary Outcome

For the patient:
- self-employment vs. neediness (short iADL assessment scale based on the "New Assessment Authority NBA" for assessing and determining the level of care; degree of care)
- neuropsychiatric symptoms easy assessment scale based on the "New Assessment Authority NBA" for assessing and determining the level of care)
- psychopharmaceuticals (medication at admission and discharge as well as changes in the course)
- hospital treatment (time to the first hospital re-hospitalization (morbidity), death of the patient (mortality), number of rehospitalizations during the investigation period, time of inpatient treatment, time of sojourn in short-term care during the investigation period)
- residential situation after discharge
- satisfaction (satisfaction with the decision taken to the place of residence after the discharge and satisfaction with the residential situation)
- quality of life (Scale Quality of Life in Alzheimer’s Disease (QOL-AD), Question No 13)

For the relative / legal guardian:
- satisfaction (satisfaction with the decision taken regarding the place of residence after the discharge and satisfaction with the patient's place of residence)
- quality of life of the relative / legal guardian (Scale Quality of Life in Alzheimer’s Disease (QOL-AD), Question No 13)

Recorded and documented through the semi-standardized interviews the survey takes place with a relative / legal guardian of the patient in the control group as well as in the intervention group shortly before and shortly after the release, as well as in the course of 3 times each in 3-month intervals. The interview guide was redesigned on the researcher's side.

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Countries of Recruitment

  •   Germany
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Locations of Recruitment

  • University Medical Center 
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Recruitment

  •   Actual
  •   2017/11/01
  •   50
  •   Monocenter trial
  •   National
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Inclusion Criteria

  •   Both, male and female
  •   75   Years
  •   90   Years
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Additional Inclusion Criteria

The patient resides in a home environment before hospitalization and has a diagnosed dementia or documented suspicion of dementia. Alternative: The patient resides in a home environment before hospitalization. He / she is 75 years old or older and has a noticeable result in the watch test.

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Exclusion Criteria

The patient has a psychiatric disorder in his / her medical history. The communication with the patient or an informed person (relative / legal guardian) is not possible due to language barriers. The patient is treated for less than 3 days in the recruiting station. No informed partner is available.

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Addresses

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    • Uniklinikum Magdeburg A. ö. R.
    • Leipziger Str. 44
    • 39120  Magdeburg
    • Germany
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    • DZNE Deutsches Zentrum für Neurodegenerative Erkrankungen
    • Leipziger Str. 44
    • 39120  Magdeburg
    • Germany
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    • DZNE Deutsches Zentrum für Neurodegenerative Erkrankungen
    • Mr.  Prof. Dr. med.  Notger  Müller 
    • Leipziger Str. 44
    • 39120  Magdeburg
    • Germany
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    • DZNE Deutsches Zentrum für Neurodegenerative Erkrankungen
    • Mr.  Prof. Dr. med.  Notger  Müller 
    • Leipziger Str. 44
    • 39120  Magdeburg
    • Germany
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Sources of Monetary or Material Support

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    • Otto und Edith Mühlschlegel Stiftung in der Robert Bosch Stiftung
    • 70184  Stuttgart
    • Germany
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Status

  •   Recruiting ongoing
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Trial Publications, Results and other Documents

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* This entry means the parameter is not applicable or has not been set.