Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Health Care Sciences & Services, Health services research, Integrated care, Interprofessional, Polymorbidity, Transition, Discharge planning, Clinical outcomes, Length of hospital stay, Readmission, Resource allocation, HEALTH-CARE, IMPLEMENTATION SCIENCE, MULTIMORBIDITY, GUIDELINES, EDUCATION, DISEASES, SYSTEM, MODEL, Adolescent, Adult, Aged, Humans, Middle Aged, Young Adult, Benchmarking, Clinical Trials as Topic, Comparative Effectiveness Research, Delivery of Health Care, Delivery of Health Care, Integrated, Hospitalization, Interprofessional Relations, Length of Stay, Multicenter Studies as Topic, Multiple Chronic Conditions, Patient Discharge, Patient Readmission, Patient Transfer, Pragmatic Clinical Trials as Topic, Prospective Studies, Quality of Health Care, Resource Allocation, 0807 Library and Information Studies, 1110 Nursing, 1117 Public Health and Health Services, Health Policy & Services, 4203 Health services and systems, 4205 Nursing, 4206 Public health

Abstract:

BACKGROUND: A comprehensive in-hospital patient management with reasonable and economic resource allocation is arguably the major challenge of health-care systems worldwide, especially in elderly, frail, and polymorbid patients. The need for patient management tools to improve the transition process and allocation of health care resources in routine clinical care particularly for the inpatient setting is obvious. To address these issues, a large prospective trial is warranted. METHODS: The "Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay" (In-HospiTOOL) study is an investigator-initiated, multicenter effectiveness trial to compare the effects of a novel in-hospital management tool on length of hospital stay, readmission rate, quality of care, and other clinical outcomes using a time-series model. The study aims to include approximately 35`000 polymorbid medical patients over an 18-month period, divided in an observation, implementation, and intervention phase. Detailed data on treatment and outcome of polymorbid medical patients during the in-hospital stay and after 30 days will be gathered to investigate differences in resource use, inter-professional collaborations and to establish representative benchmarking data to promote measurement and display of quality of care data across seven Swiss hospitals. The trial will inform whether the "In-HospiTOOL" optimizes inter-professional collaboration and thereby reduces length of hospital stay without harming subjective and objective patient-oriented outcome markers. DISCUSSION: Many of the current quality-mirroring tools do not reflect the real need and use of resources, especially in polymorbid and elderly patients. In addition, a validated tool for optimization of patient transition and discharge processes is still missing. The proposed multicenter effectiveness trial has potential to improve interprofessional collaboration and optimizes resource allocation from hospital admission to discharge. The results will enable inter-hospital comparison of transition processes and accomplish a benchmarking for inpatient care quality.