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© 2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Introduction

Older adults with an acute moderate-to-severe lower respiratory tract infection (LRTI) or pneumonia are generally treated in hospitals causing risk of iatrogenic harm such as functional decline and delirium. These hospitalisations are often a consequence of poor collaboration between regional care partners, the lack of (acute) diagnostic and treatment possibilities in primary care, and the presence of financial barriers. We will evaluate the implementation of an integrated regional care pathway (‘The Hague RTI Care Bridge’) developed with the aim to treat and coordinate care for these patients outside the hospital.

Methods and analysis

This is a prospective mixed methods study. Participants will be older adults (age≥65 years) with an acute moderate-to-severe LRTI or pneumonia treated outside the hospital (care pathway group) versus those treated in the hospital (control group). In addition, patients, their informal caregivers and treating physicians will be asked about their experiences with the care pathway. The primary outcome of this study will be the feasibility of the care pathway, which is defined as the percentage of patients treated outside the hospital, according to the care pathway, whom fully complete their treatment without the need for hospitalisation within 30 days of follow-up. Secondary outcomes include the safety of the care pathway (30-day mortality and occurrence of complications (readmissions, delirium, falls) within 30 days); the satisfaction, usability and acceptance of the care pathway; the total number of days of bedridden status or hospitalisation; sleep quantity and quality; functional outcomes and quality of life.

Ethics and dissemination

The Medical Research Ethics Committee Leiden The Hague Delft (reference number N22.078) has confirmed that the Medical Research Involving Human Subjects Act does not apply to this study. The results will be published in international peer-reviewed journals.

Trial registration number

ISRCTN68786381.

Details

Title
Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study
Author
Roos, Rick 1   VIAFID ORCID Logo  ; Pepping, Rianne M C 1 ; van Aken, Maarten O 1 ; Labots, Geert 2 ; Lahdidioui, Ali 2 ; Johanna M W van den Berg 3 ; Kolfschoten, Nikki E 4 ; Pasha, Sharif M 5 ; ten Holder, Joris T 6 ; Mollink, Susan M 7 ; Frederiek van den Bos 8 ; Kant, Jojanneke 9 ; Kroon, Ingrid 10 ; Vos, Rimke C 11   VIAFID ORCID Logo  ; Numans, Mattijs E 11 ; Cees van Nieuwkoop 1   VIAFID ORCID Logo 

 Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands; Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands 
 Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands 
 Department of Pulmonology, Haga Teaching Hospital, The Hague, The Netherlands 
 Department of Emergency Medicine, Haga Teaching Hospital, The Hague, The Netherlands 
 Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands 
 Department of Pulmonology, Haaglanden Medical Center, The Hague, The Netherlands 
 Department of Emergency Medicine, Haaglanden Medical Center, The Hague, The Netherlands 
 Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands 
 Hadoks, The Hague, The Netherlands 
10  Kroon Elderly Care Physician, The Hague, The Netherlands 
11  Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands 
First page
e073126
Section
Geriatric medicine
Publication year
2023
Publication date
2023
Publisher
BMJ Publishing Group LTD
e-ISSN
20446055
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2851955490
Copyright
© 2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.