Effect of an interprofessional care concept on the hospitalization of nursing home residents : study protocol for a cluster-randomized controlled trial

Background: The rising number of nursing home (NH) residents and their increasingly complex treatment needs pose a challenge to the German health care system. In Germany, there is no specialized geriatric medical care for NH residents. Nursing staff and general practitioners (GPs) in particular have to compensate for the additional demand, which is compounded by organizational and structural hurdles. As a result, avoidable emergency calls and hospital admissions occur. In the SaarPHIR project (Saarländische PflegeHeimversorgung Integriert Regelhaft), a complex intervention focusing on a medical care concept was developed in a participatory practice-based approach involving NH representatives and GPs. The complex intervention addresses the collaboration between nurses and GPs and aims to help restructure and optimize the existing daily care routine. It is expected to improve the medical care of geriatric patients in NHs and reduce stressful, costly hospital admissions. The intervention was pilot-tested during the first 12 months of the project. In the present study, its effectiveness, cost-effectiveness, and safety will be evaluated. Methods: The study is a cluster-randomized controlled trial, comparing an intervention group with a control group. The intervention includes a concept of interprofessional collaboration, in which GPs group into regional cooperating teams. Teams are encouraged to cooperate more closely with NH staff and to provide on-call schedules, pre-weekend visits, joint team meetings, joint documentation, and improved medication safety. At least 32 NHs in Saarland, Germany (with at least 50 residents each) will be included and monitored for 12 months. The primary endpoint is hospitalization. Secondary endpoints are quality of life, quality of care, and medication safety. The control group receives treatment as usual. Process evaluation and health economic evaluation accompany the study. The data set contains claims data from German statutory health insurance companies as well as primary data. Analysis will be conducted using a generalized linear mixed model. Conclusion: A reduction in hospital admissions of NH residents and relevant changes in secondary endpoints are expected. In turn, these will have a positive impact on the economic assessment

Additional file 3 of Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

Additional file 3. Multivariate Analysis – Effect Likelihood Ratio Tests (ADL, IADL, WHOQOL-BREF, WHOQOL-OLD)

Additional file 1 of Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

Additional file 1. Bivariate Analysis of ADL

Additional file 4 of Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

Additional file 4. Bivariate Analysis of WHOQOL-BREF, WHOQOL-OLD

Additional file 2 of Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

Additional file 2. Bivariate Analysis of IADL

RubiN – continuous care in regional networks: a study protocol for a prospective controlled trial

Background!#!The health care situation of geriatric patients is often multifaceted, complex and often overlaps with social living conditions. Due to the lack of cross-sectoral and interprofessional health care geriatric patients often, receive insufficient care. Only a holistic view enables a comprehensive evaluation of the complex health risks, but also the potential to preserve the health of geriatric patients. The implementation of cross-sectoral, multi-professional case management could reduce the gaps in care, improve the autonomy of the geriatric patients in their own homes, and allow them to retain it as long as possible. The 'RubiN' project examines the effects of multi-professional, cross-sectoral and assessment-based case management on the quality of the care of geriatric patients. The results of the study aim to show whether geriatric patients receive better care using case management than patients who receive standard health care. In addition, data on the effects of case management on practices of general practitioners (GP), the satisfaction with the care concept amongst the case managers, patients and relatives will be collected. Furthermore, a health economic analysis will be carried out.!##!Methods!#!The project is designed as a prospective controlled study and compares geriatric patients from practice networks in different regions in Germany. Inclusion criteria are: Age ≥ 70 years and care requirements from two different care complexes (identified with the screening instrument 'Angelina'-questionnaire). The intervention is the use of a geriatric case management, where health care is organised based on patient-specific care requirements. Five practice networks of physicians will implement the intervention (n = 3200 patients) and three practice networks will serve as the control group (n = 1200 patients). The primary endpoint is the ability to manage activities of daily living, measured using the Barthel Index. The patients in the intervention group receive geriatric case management and the patients in the control networks receive standard care ('care as usual'). The analysis of the primary data, which is pseudonymised, occurs according to the intention-to-treat principle. For this purpose, the endpoints will be analysed using a group comparison after 12 months. For the health economic analysis, secondary data from the statutory health insurance providers will be included in the analysis, in addition to the primary data. Data for the analysis of the effects the concept has on the GP practices as well as on the satisfaction of the project participants will be collected with questionnaires and interviews with experts.!##!Discussion!#!The implementation of cross-sectoral and interdisciplinary geriatric case management has been a topic of discussion for years, whereby positive effects have already been-shown. This planned study will be the first evaluation of the effect of case management for geriatric patients with a very large sample. In addition, the effects of case management on the GP practices and also on the relatives of the geriatric patients will be shown. It is intended that the study results pave the way for a widespread implementation of this concept.!##!Trial registration!#!German Clinical Trials Register, ID: DRKS00016642 . Registered on 29 October 2019 - Retrospectively registered

Chronological Assessment of the Balta Alba Kurgan Loess-Paleosol Section (Romania) - A Comparative Study on Different Dating Methods for a Robust and Precise Age Model

Loess-paleosol sequences (LPSs) are important terrestrial archives of paleoenvironmental and paleoclimatic information. One of the main obstacles for the investigation and interpretation of these archives is the uncertainty of their age-depth relationship. In this study, four different dating techniques were applied to the Late Pleistocene to Holocene LPS Balta Alba Kurgan (Romania) in order to achieve a robust chronology. Luminescence dating includes analysis of different grain-size fractions of both quartz and potassium feldspar and the best results are obtained using fine-grained quartz blue-stimulated and polymineral post-infrared infrared-stimulated luminescence measurements. Radiocarbon (C-14) dating is based on the analysis of bulk organic carbon (OC) and compound-specific radiocarbon analysis (CSRA). Bulk OC and leaf wax-derived n-alkane C-14 ages provide reliable age constraints for the past c. 25-27 kyr. CSRA reveals post-depositional incorporation of roots and microbial OC into the LPS limiting the applicability of C-14 dating in older parts of the sequence. Magnetic stratigraphy data reveal good correlation of magnetic susceptibility and the relative paleointensity of the Earth's magnetic field with one another as well as reference records and regional data. In contrast, the application of paleomagnetic secular variation stratigraphy is limited by a lack of regional reference data. The identification of the Campanian Ignimbrite/Y-5 tephra layer in the outcrop provides an independent time marker against which results from the other dating methods have been tested. The most accurate age constraints from each method are used for two Bayesian age-depth modeling approaches. The systematic comparison of the individual results exemplifies the advantages and disadvantages of the respective methods. Taken as a whole, the two age-depth models agree very well, our study also demonstrates that the multi-method approach can improve the accuracy and precision of dating loess sequences

Chronological Assessment of the Balta Alba Kurgan Loess-Paleosol Section (Romania) : A Comparative Study on Different Dating Methods for a Robust and Precise Age Model

Loess-paleosol sequences (LPSs) are important terrestrial archives of paleoenvironmental and paleoclimatic information. One of the main obstacles for the investigation and interpretation of these archives is the uncertainty of their age-depth relationship. In this study, four different dating techniques were applied to the Late Pleistocene to Holocene LPS Balta Alba Kurgan (Romania) in order to achieve a robust chronology. Luminescence dating includes analysis of different grain-size fractions of both quartz and potassium feldspar and the best results are obtained using fine-grained quartz blue‐stimulated and polymineral post-infrared infrared-stimulated luminescence measurements. Radiocarbon (14C) dating is based on the analysis of bulk organic carbon (OC) and compound-specific radiocarbon analysis (CSRA). Bulk OC and leaf wax-derived n-alkane 14C ages provide reliable age constraints for the past c. 25–27 kyr. CSRA reveals post-depositional incorporation of roots and microbial OC into the LPS limiting the applicability of 14C dating in older parts of the sequence. Magnetic stratigraphy data reveal good correlation of magnetic susceptibility and the relative paleointensity of the Earth’s magnetic field with one another as well as reference records and regional data. In contrast, the application of paleomagnetic secular variation stratigraphy is limited by a lack of regional reference data. The identification of the Campanian Ignimbrite/Y-5 tephra layer in the outcrop provides an independent time marker against which results from the other dating methods have been tested. The most accurate age constraints from each method are used for two Bayesian age-depth modeling approaches. The systematic comparison of the individual results exemplifies the advantages and disadvantages of the respective methods. Taken as a whole, the two age-depth models agree very well, our study also demonstrates that the multi-method approach can improve the accuracy and precision of dating loess sequences

Effectiveness of a complex regional advance care planning intervention to improve care consistency with care preferences: study protocol for a multi-center, cluster-randomized controlled trial focusing on nursing home residents (BEVOR trial)

According to recent legislation, facilitated advance care planning (ACP) for nursing home (NH) residents is covered by German sickness funds. However, the effects of ACP on patient-relevant outcomes have not been studied in Germany yet. This study investigates whether implementing a complex regional ACP intervention improves care consistency with care preferences in NH residents.7702