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| Name | Class |
|---|---|
| Health Department of the Canton of Basel-Stadt | OTHER_GOV |
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This clinical trial at the University Department of Geriatric Medicine FELIX Platter in Basel, Switzerland, is designed to evaluate a new transitional care model aimed at helping frail older adults after they get discharged from the hospital. The AdvantAGE study aims to explore the following questions:
Participants in the trial will be followed by advanced practice nurses for up to 90 days after hospital discharge. The patients and their caregivers will receive support in coordinating care, managing medications, and learning to manage the patient's health conditions on their own. Additionally, they will have the opportunity to engage in discussions about advanced care planning.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | The intervention includes five core elements provided by a multiprofessional team: (1) continuous support for patients and caregivers; (2) care coordination with primary care providers;(3) visits at patients' homes; (4) medication- and self-management with patients and caregivers; and (5) proactive advanced care planning. Patients will receive specialized support including home visits up to 90 days after hospital discharge. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transitional care model | Other | A newly developed care model to support frail older adults during their transition from hospital to home. |
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| Measure | Description | Time Frame |
|---|---|---|
| 90-days rehospitalization rate | Number of unplanned hospital admissions of any kind happening within 90 days after discharge | 90 days post-discharge |
| Measure | Description | Time Frame |
|---|---|---|
| 30-days rehospitalization rate | Number of unplanned hospital admission of any kind happening within 30 days after discharge | 30 days post-discharge |
| Time to readmission | Number of days between hospital discharge and unplanned hospital admission |
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Inclusion Criteria:
Additionally, participants must meet at least one of the following criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mario Ernst | Contact | +41 61 326 44 81 | mario.ernst@felixplatter.ch | |
| Isabel Pfundstein | Contact | +41 61 326 44 81 | isabel.pfundstein@felixplatter.ch |
| Name | Affiliation | Role |
|---|---|---|
| Thekla Brunkert, PhD | Universitäre Altersmedizin FELIX PLATTER | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Universitäre Altersmedizin FELIX PLATTER | Recruiting | Basel | 4055 | Switzerland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39865439 | Derived | Brunkert T, Pfundstein I, Nickel CH, Lampert ML, Trutschel D, Mauthner O. AdvantAGE: Implementation and Evaluation of an Interprofessional Transitional Care Model for Frail Older Adults-Protocol of an Effectiveness-Implementation Hybrid Study. J Adv Nurs. 2025 Aug;81(8):5130-5142. doi: 10.1111/jan.16745. Epub 2025 Jan 26. |
| Label | URL |
|---|---|
| project homepage (in German) | View source |
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| ID | Term |
|---|---|
| D000073496 | Frailty |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| C082359 | imidacloprid |
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Hybrid effectiveness-implementation study (type 1)
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| Up to 90 days post-discharge |
| Number of emergency room visits | Number of emergency room visits (with or without hospital admission) within 90 days after discharge | 90 days post-discharge |
| Time to emergency room visit | Number of days between hospital discharge and emergency room visit | Up to 90 days post-discharge |
| Patient's health-related quality of life | The EuroQoL-5D-5L is used to assess the health-related quality of life in patients at three time points. Prior to hospital discharge, 7 days and 90 days after hospital discharge or if the patient completed the intervention | Up to 90 days post-discharge |
| Patient satisfaction questionnaire | Satisfaction regarding intervention participation | up to 90 days post-discharge |