Screening by Social Workers in Medical Patients with Risk of Post-Acute Care Needs: A Stepped Wedge Cluster Randomized Trial / Evaluation eines Screenings durch Sozialarbeiter bei medizinischen Patienten mit einem Risiko für post-akuten Nachsorgebedarf: eine stepped wedge clusterrandomisierte Studie
, , , , , , , , , , , , , , , , and | Apr 25, 2018
About this article
Published Online: Apr 25, 2018
Page range: 25 - 34
Received: Jan 05, 2017
Accepted: Dec 22, 2017
DOI: https://doi.org/10.2478/ijhp-2018-0003
Keywords
© 2018 Antoinette Conca, Doaa Ebrahim, Sandra Noack, Angela Gabele, Helen Weber, Mehrnaz Prins, Anja Keller, Mariann Hari, Angela Engel, Katharina Regez, Ursula Schild, Philipp Schuetz, Beat Müller, Sebastian Haubitz, Alexander Kutz, Andreas Huber, Lukas Faessler, Petra Schäfer-Keller
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
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Affected organ system (main diagnosis) of the patients with SW notification
| Intervention period (n = 62) | Control period (n = 58) | |
|---|---|---|
| Infections | 26% | 17% |
| Respiratory system | 19% | 17% |
| Cardiovascular system | 14% | 19% |
| Digestive system | 10% | 7% |
| Neoplasms | 8% | 9% |
| Nervous system | 8% | 5% |
| Genitourinary system | 2% | 7% |
| Others | 13% | 19% |
ADL, IADL and unavailability of help at home
| Intervention period (n = 62) | Control period (n = 58) | p-Value | |
|---|---|---|---|
| PACD total score (M, SD) | 13 (± 4.7) | 13 (± 4.4) | .91 |
| Needs help in general | 77.4% | 74.1% | .68 |
| Help with personal hygiene | 46.8% | 44.8% | .83 |
| Help with dressing/undressing | 37.1% | 31.0% | .48 |
| Help with toileting (urine/defecation) | 19.4% | 20.7% | .86 |
| Help with bathing / showering | 53.2% | 41.4% | .19 |
| Help with mobility | 37.1% | 24.1% | .13 |
| Help with eating / drinking | 14.5% | 15.5% | .88 |
| Help with transfer (bed / chair) | 24.2% | 20.7% | .65 |
| Help with transportation (car / public) | 66.1% | 46.6% | .03 |
| Help with shopping | 71.0% | 50.0% | .02 |
| Help with cooking | 59.7% | 50.0% | .29 |
| Help with house keeping | 69.4% | 63.8% | .52 |
| Help with medication management | 45.2% | 44.8% | .97 |
| Unavailability of help at home | 45.9% | 54.1% | .20 |
| Help with transfer on day 3 | 56.1% | 34.0% | .02 |
| Help with bathing / showering on day 3 | 84.2% | 71.7% | .11 |
Unadjusted time to SW notification, hospital length of stay and delayed discharge time in nights
| Intervention period (n = 62) | Control period (n = 58) | p-Value | |||
|---|---|---|---|---|---|
| Median | IQR | Median | IQR | ||
| Time to SW notification | 1.2 | 1.9 | 1.7 | 2.4 | .42 |
| Hospital length of stay | 10.0 | 8.9 | 9.1 | 6.4 | .41 |
| Delayed discharge time | 0.0 | 2.5 | 0.0 | 1.4 | .39 |
GEE Results for the dependent variable: length of stay
| Model adjusted for calendar days, help with transportation, help with shopping (day 1), and help with transfer (day 3) | ||||||
|---|---|---|---|---|---|---|
| day 1 adjusted (n=120) | day 1 & 3 adjusted (n=110) | |||||
| ß | CI (95%) | p-Value | ß | CI (95%) | p-Value | |
| Intervention | .001 | -.358 to .360 | .995 | -.119 | -.460 to .221 | .492 |
| Control | - | - | Referent | - | - | Referent |
| Calendar days | .004 | -.003 to .010 | .298 | .004 | -.022 to .011 | .180 |
| No help with transportation | -.140 | -.377 to .096 | .246 | -.088 | -.296 to .120 | .408 |
| Help with transportation | - | - | Referent | - | - | Referent |
| No help with shopping | .239 | -.028 to .506 | .079 | .159 | -.055 to .373 | .145 |
| Help with shopping | - | - | Referent | - | - | Referent |
| No help with transfer day 3 | - | - | - | .009 | -.211 to .228 | .939 |
| Help with transfer day 3 | - | - | - | - | - | Referent |
GEE Results for the dependent variable: discharge delay
| Model adjusted for calendar days, help with transportation, help with shopping (day 1), and help with transfer (day 3) | |||||||
|---|---|---|---|---|---|---|---|
| day 1 adjusted (n=120) | day 1 & 3 adjusted (n=110) | ||||||
| ß | CI (95%) | p-Value | ß | CI (95%) | p-Value | ||
| Intervention | .090 | -.560 to .740 | .786 | .110 | -.637 to .857 | .773 | |
| Control | - | - | Referent | - | Referent | ||
| Calendar days | .005 | -.009 to .019 | .498 | .003 | -.013 to .019 | .713 | |
| No help with transportation | -.722 | -1.231 to -.214 | .005 | -.764 | -1.312 to -.217 | .006 | |
| Help with transportation | - | - | Referent | - | - | Referent | |
| No help with shopping | .798 | .295 to 1.300 | .002 | .689 | .122 to 1.256 | .017 | |
| Help with shopping | - | - | Referent | - | - | Referent | |
| No help with transfer day 3 | - | - | - | .084 | -.314 to .482 | .680 | |
| Help with transfer day 3 | - | - | - | - | - | Referent | |
Admission from and discharge to places for patients notified to SW services
| (n=120) | Admitted from | Discharged to | ||
|---|---|---|---|---|
| Intervention | Control | Intervention | Control | |
| Home | 82.3% | 70.7% | 17.8% | 15.5% |
| Home with home care service | 11.3% | 20.7% | 24.2% | 24.1% |
| Geriatric home, other social medical institutions | 0% | 1.7% | 6.5% | 8.6% |
| Nursing home | 1.6% | 1.7% | 20.9% | 22.5% |
| Rehabilitation | NA | 25.8% | 22.4% | |
| Psychiatric clinic | 0% | 1.7% | NA | |
| Acute hospital | NA | 1.6% | 1.7% | |
| Others | 4.8% | 3.5% | 3.2% | 5.2% |
GEE Results for the dependent variable: SW notification
| Model adjusted for calendar days, help with transportation, help with shopping (day 1), and help with transfer (day 3) | ||||||
|---|---|---|---|---|---|---|
| day 1 adjusted (n = 120) | day 1 & 3 adjusted (n = 110) | |||||
| ß | CI (95%) | p-Value | ß | CI (95%) | p-Value | |
| Intervention | -.548 | -1.155 to .060 | .077 | -.736 | -1.387 to -.085 | .027 |
| Control | - | - | Referent | - | - | Referent |
| Calendar days | .010 | -.003 to .022 | .142 | .009 | -.005 to 0.22 | .212 |
| No help with transportation | .127 | -.418 to .671 | .648 | .052 | -.475 to .580 | .846 |
| Help with transportation | - | Referent | - | - | Referent | |
| No help with shopping | .003 | -.586 to .591 | .993 | -.148 | -.656 to .361 | .570 |
| Help with shopping | - | - | Referent | - | - | Referent |
| No help with transfer day 3 | - | - | - | .165 | -.281 to .611 | .469 |
| Help with transfer day 3 | - | - | - | - | - | Referent |