Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| Sahlgrenska University Hospital | OTHER |
| Lund University | OTHER |
| University College Copenhagen | OTHER |
| Ostfold University College |
Not provided
Not provided
Not provided
Not provided
To enhance implementation of Hospital-at-home (HaH) in Scandinavia, the Nordic Digital Health & Education (NorDigHE) project has developed a comprehensive virtual education on HaH for clinical staff. The goal of this clinical trial is to evaluate whether an online education for clinical staff can enhance the implementation of HaH services in hospitals across Denmark, Norway, and Sweden.
The primary outcome of the RCT is HaH implementation measured at organization level, understood as a change in clinical practice by increased HaH activity. Secondary outcomes are HaH knowledge and motivation among clinical staff as well as patient days in hospital, days hospitalized at home, 30-day readmission, and mortality.
Researchers will compare hospitals receiving the NorDigHE education (intervention group) to hospitals continuing treatment as usual (control group) to see if the education leads to greater adoption of HaH and changes in service delivery.
Participants will:
After the study, the control group will be offered access to the NorDigHE education as a participant retention measure.
Background: In response to increasing pressures on healthcare systems due to aging populations, and increasing shortages of clinical staff, increased use of digital service designs has been recommended by most governments in Scandinavian and European countries. Virtually supported Hospital-at-Home (HaH) models, delivering acute hospital services in-home have been shown to be both feasible and beneficial. Nevertheless, implementation and scaling barriers are major challenges. To enhance implementation of HaH in Scandinavia, the Nordic Digital Health & Education (NorDigHE) project has developed a compre-hensive virtual education on HaH for clinical staff. The present study aims to evaluate the implementation impact of the NorDigHE education embedded in the WHO Fast-track Implementation Model (WHO Fast-IM).
Methods and analysis: We use a randomized design and nested qualitative studies to meet the aim. Via open-call, hospitals will be recruited in Denmark, Norway, and Sweden and randomized to either receive the education embedded in the WHO Fast-IM or to continue treatment as usual. The primary outcome of the RCT is HaH implementation measured at organization level, understood as a change in clinical practice by increased HaH activity. Secondary outcomes are HaH knowledge and motivation among clinical staff as well as patient days in hospital, days hospitalized at home, 30-day readmission, and mortality. Data are collected at baseline, after 3, and 6 months. A 12-month maintenance measurement is performed in the intervention group. Post-study, the control group is offered the NorDigHE education as a participant re-tention measure. In addition, the attitudes, experiences, and preferences of HaH among patients, clinical staff, and management are collected via nested semi-structured interviews.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | The intervention group receives the NorDigHE HaH education embedded in the WHO Fast-IM. |
|
| Control group | No Intervention | The control group continues treatment as usual over a 6-month period. To enhance participant retention, the control group will be offered the education after study completion and as a quality initiative. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| HaH education | Behavioral | The intervention consists of the online NorDigHE HaH education with tailored implementation tools em-bedded in the WHO Fast-IM. The education is delivered online and asynchronously, combining e-learning, simulations, reflection exercises, and practical task training. The trial has adopted the evidence-based WHO Fast-track Implementation Model (WHO Fast-IM) as a framework to support the effectiveness and reporting of the implementation, and the tailored implementation tools embedded in the model will be provided as part of the intervention to support in-tegration into daily clinical routines. The tailored toolbox consists of workshops, introductory meetings, written guides, and access to a hotline staffed by project specialists to facilitate implementation. |
| Measure | Description | Time Frame |
|---|---|---|
| HaH implementation | The primary outcome, HaH implementation at the organizational level, is defined as a change in clinical practice, measured by the proportion of eligible patients who receive HaH. | From enrollment until 6 months follow-up measurement |
| Measure | Description | Time Frame |
|---|---|---|
| Staff's motivation | Staff's motivation to work with HaH. Staff HaH motivation is measured by Intrinsic Motivation Inventory (IMI) Scale questionnaires. Participants will be presented with a series of statements and asked to indicate how true each statement is for them on a 7-point scale, where 1 represents 'not true at all' and 7 represents 'very true'. | From enrollment until 6 months follow-up |
Not provided
Inclusion criteria:
Hospitals with clinical departments treating acutely ill in-patients that have, or are ready to establish, the prerequisites and infrastructure for HaH - regardless of the specific approach, envisioned HaH model, primary sector collaborations, or local sector collaboration agreements and frameworks. Each hospital must have or be ready to establish:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mie H Martinussen | Contact | +45 20529362 | mie.hjort.martinussen@regionh.dk | |
| Jeff K Svane | Contact | +45 20544105 | mie.hjort.martinussen@regionh.dk |
| Name | Affiliation | Role |
|---|---|---|
| Thea K Fischer | Forskningsafdelingen, Nordsjællands Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Nordsjællands Hospital | Recruiting | Hillerød | Capitol Region of Denmark | 3400 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22310560 | Background | Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012 Mar;50(3):217-26. doi: 10.1097/MLR.0b013e3182408812. | |
| 37587521 | Background | Foy R, Ivers NM, Grimshaw JM, Wilson PM. What is the role of randomised trials in implementation science? Trials. 2023 Aug 16;24(1):537. doi: 10.1186/s13063-023-07578-5. |
| Label | URL |
|---|---|
| World Health Organization, Global strategy on human resources for health: workforce 2030. Geneva: World Health Organization, 2016. Seen: 6. juni 2024. | View source |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| OTHER |
| Region Capital Denmark | OTHER |
The study is designed as a two-armed, multicenter, superiority, cluster-randomized clinical trial with the hospital as the unit of randomization. The participating hospitals will autonomously select the relevant clinical departments and related staff to undergo the education tested. Data are collected at baseline, after 3, and 6 months. The intervention group also collects a 12-month maintenance assessment.
Not provided
Not provided
Not provided
|
|
| Staff's knowledge | Staff members' knowledge on HaH. Staff's knowledge is collected as pre- and post-education questionnaires at baseline and at 6 months follow-up. The knowledge questionnaires have been developed prior to the study and has undergone pilot-validation with healthcare students, clinical staff, and education sector experts as part of the NorDigHE project. | From enrollment until 6 months follow-up |
| Days hospitalized at home | Length of stay while hospitalized at home versus in the hospital. Measured using registry data for patients admitted to the department during trial. | From enrollment until 6 months follow-up |
| 30-day readmission | The percentage of patients that readmit to the hospital within 30 days with the same illness they were previously discharged. Measured using registry data for patients admitted to the department during the trial. | From enrollment until 6 months follow-up |
| Mortality | Tthe number of deaths in participating hospitals (and their departments) during the trial (death rate) | From enrollment until 6 months follow-up |
| University College of Østfold | Recruiting | Fredrikstad | Østfold fylke | Norway |
|
| Sahlgrenska University hospital | Recruiting | Göteborg | Skåne County | Sweden |
|
| 22179294 | Background | Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510-20. doi: 10.1258/jrsm.2011.110180. |
| 25654366 | Background | Jakobsen AS, Laursen LC, Rydahl-Hansen S, Ostergaard B, Gerds TA, Emme C, Schou L, Phanareth K. Home-based telehealth hospitalization for exacerbation of chronic obstructive pulmonary disease: findings from "the virtual hospital" trial. Telemed J E Health. 2015 May;21(5):364-73. doi: 10.1089/tmj.2014.0098. Epub 2015 Feb 5. |
| 38780386 | Background | Sandreva T, Larsen MN, Rasmussen MK, Nielsen TL, von Sydow C, Schmidt TA, Fischer TK. Transforming health care: Investigating Influenzer, a novel telemedicine-supported early discharge program for patients with lower respiratory tract infection: A non-randomized feasibility study. J Telemed Telecare. 2025 Sep;31(8):1138-1151. doi: 10.1177/1357633X241254572. Epub 2024 May 23. |
| 37492346 | Background | Pietersen PI, Bhatnagar R, Rahman NM, Maskell N, Wrightson JM, Annema J, Crombag L, Farr A, Tabin N, Slavicky M, Skaarup SH, Konge L, Laursen CB. Evidence-based training and certification: the ERS thoracic ultrasound training programme. Breathe (Sheff). 2023 Jun;19(2):230053. doi: 10.1183/20734735.0053-2023. Epub 2023 Jul 11. |
| 34179736 | Background | Vindrola-Padros C, Singh KE, Sidhu MS, Georghiou T, Sherlaw-Johnson C, Tomini SM, Inada-Kim M, Kirkham K, Streetly A, Cohen N, Fulop NJ. Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review. EClinicalMedicine. 2021 Jul;37:100965. doi: 10.1016/j.eclinm.2021.100965. Epub 2021 Jun 23. |
| 29411238 | Background | Levine DM, Ouchi K, Blanchfield B, Diamond K, Licurse A, Pu CT, Schnipper JL. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial. J Gen Intern Med. 2018 May;33(5):729-736. doi: 10.1007/s11606-018-4307-z. Epub 2018 Feb 6. |
| 33514582 | Background | Leong MQ, Lim CW, Lai YF. Comparison of Hospital-at-Home models: a systematic review of reviews. BMJ Open. 2021 Jan 29;11(1):e043285. doi: 10.1136/bmjopen-2020-043285. |
| 34346152 | Background | Ankersen DV, Noack S, Munkholm P, Sparrow MP. E-Health and remote management of patients with inflammatory bowel disease: lessons from Denmark in a time of need. Intern Med J. 2021 Aug;51(8):1207-1211. doi: 10.1111/imj.15132. Epub 2021 Aug 3. |
| 11392867 | Background | Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000 Jan;55(1):68-78. doi: 10.1037//0003-066x.55.1.68. |
| 10474547 | Background | Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999 Sep;89(9):1322-7. doi: 10.2105/ajph.89.9.1322. |
| Background | J.K. Svane, L. Konge, and H. Tønnesen, "Fast and Well-reported Implementation: Fast-IM and RE-AIM", Clin. Health Promot. - Res. Best Pract. Patients Staff Community, bd. 10., no. 1, p. 10-14, dec. 2020, doi: 10.29102/clinhp.20003. |
| 30577871 | Background | Svane JK, Chiou ST, Groene O, Kalvachova M, Brkic MZ, Fukuba I, Harm T, Farkas J, Ang Y, Andersen MO, Tonnesen H. A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH). Implement Sci. 2018 Dec 22;13(1):153. doi: 10.1186/s13012-018-0848-0. |
| 28651296 | Background | Goncalves-Bradley DC, Iliffe S, Doll HA, Broad J, Gladman J, Langhorne P, Richards SH, Shepperd S. Early discharge hospital at home. Cochrane Database Syst Rev. 2017 Jun 26;6(6):CD000356. doi: 10.1002/14651858.CD000356.pub4. |
| 38438114 | Background | Wallis JA, Shepperd S, Makela P, Han JX, Tripp EM, Gearon E, Disher G, Buchbinder R, O'Connor D. Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2024 Mar 5;3(3):CD014765. doi: 10.1002/14651858.CD014765.pub2. |
| 38438116 | Background | Edgar K, Iliffe S, Doll HA, Clarke MJ, Goncalves-Bradley DC, Wong E, Shepperd S. Admission avoidance hospital at home. Cochrane Database Syst Rev. 2024 Mar 5;3(3):CD007491. doi: 10.1002/14651858.CD007491.pub3. |
| European Commission, "CORDIS programne: Societal Challenges - Health, demographic change and well-being", EU, H2020-EU.3.1., 2014. \[Online\]. | View source |
| NOU: Norges offentlige utredninger, "Tid for handling: Personellet i en bærekraftig helse- og omsorgstjeneste", Departementenes sikkerhets- og serviceorganisasjon Teknisk redaksjon, 2023:4, 2023. \[Online\]. | View source |
| Kommissionen for robusthed i sundhedsvæsenet, "Robusthedskommissionens anbefalinger", sep. 2023. \[Online\]. | View source |
| Socialdepartementet SE, "Effektiv och behovsbaserad digital vård", Ds 2023:27, 2023. \[Online\]. | View source |
| M. Monalto, "Definition: What is Hospital at Home? \| WHAHC", WHAHC-community. Seen: 4. februar 2025. \[Online\]. | View source |
| "NorDigHE.org", Nordighe. Seen: 4. februar 2025. \[Online\] | View source |
| "Skillhabit". Set: 3. februar 2025. \[Online\]. | View source |
| D. L. Kirkpatrick, "The Kirkpatrick Model", Kirkpatrick Partners, LLC. | View source |
| Better use of home monitoring. Experience from five departments of cardiology in the Capital Region of Denmark. | View source |
| "The Hospital moves into the living room during the pandemic". A.G. Poulsen, 2024 | View source |
| "WARD Home Pilot - WARD Project" | View source |
| "Projects - DEFACTUM - Social, sundhed og arbejdsmarked" | View source |
| Erfaringer med Fremskudt akutfunktion på kommunale sengepladser i eHospitalet, Region Sjælland | View source |