Project

Back to overview

Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay - the In-HospiTOOL study

English title Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay - the In-HospiTOOL study
Applicant Müller Beat
Number 167376
Funding scheme NRP 74 Smarter Health Care
Research institution Universität Basel
Institution of higher education University of Basel - BS
Main discipline Internal Medicine
Start/End 01.01.2017 - 31.12.2020
Approved amount 840'452.00
Show all

All Disciplines (7)

Discipline
Internal Medicine
Rehabilitation
Medico-Social Problems of the Elderly
Medical Statistics
Geriatrics
Public Health and Health Services
Methods of Epidemiology and Preventive Medicine

Keywords (7)

Inter-professional collaboration; Health care research; Implementation; Benchmarking; Resource allocation; Quality; Patient flow

Lay Summary (German)

Lead
Eine verbesserte interprofessionelle Zusammenarbeit soll die Dauer des Spitalaufenthalts für Patientinnen und Patienten mit Mehrfacherkrankungen bei gleichem Behandlungserfolg verkürzen. Die Studie untersucht die Wirksamkeit und Generalisierbarkeit von interprofessionellen Instrumenten.
Lay summary

Stationäre Spitalbehandlungen tragen massgeblich zur Kostenexplosion im Gesundheitswesen bei. In den Spitälern fehlen  evidenzbasierte Daten und alltagsrelevante Instrumente, um die Dauer und Qualität der stationären Behandlungen sowie die Überweisungen an andere Abteilungen oder Institutionen zu optimieren und zu vergleichen. Am Kantonsspital Aarau entwickelte interprofessionelle Instrumente sollen mithilfe des elektronischen Klinik-Informationssystems eine Lücke füllen.  Ziel ist es, die Wirksamkeit der interprofessionellen Instrumente in Bezug auf die Dauer des stationären Spitalaufenthalts zu untersuchen, die interprofessionelle Zusammenarbeit optimiert und ein patientenzentriertes Monitoring der stationären Behandlungsqualität etabliert werden. Mindestens fünf Akutspitäler mit insgesamt 45‘000 Patienten beteiligen sich an der Studie. Ab Spitaleintritt erfassen die zuständigen Ärztinnen und Ärzte, die Pflegefachpersonen und der Sozialdienst mit spezifischen interprofessionellen Instrumenten die Daten zum Aufenthalt, zur Entlassung sowie zum allfälligen Wiedereintritt. Zudem werden die Patienten 30 Tage nach der Entlassung telefonisch zu ihrer Zufriedenheit und zum Gesundheitszustand befragt. Der Vergleich vor, während und nach Einführung der interprofessionellen Instrumente und mit Daten von nicht beteiligten Spitälern soll Hinweise auf die Wirksamkeit der Instrumente geben. Weiter werden Unterschiede und Hürden in der interprofessionellen Zusammenarbeit sowie Gründe für verzögerte Spitalentlassungen analysiert. Die Daten sollen in ein Monitoring der Behandlungsqualität (so genanntes Cockpit) einfliessen.  Das Produkt der Studie bilden validierte Instrumente für die interprofessionelle Zusammenarbeit sowie ein Monitoring zur Behandlungsqualität im Spital. Die Studie generiert zudem Daten zur Handhabung der interprofessionellen Zusammenarbeit, zu Übergangsprozessen sowie zu polymorbiden älteren Patienten. 

Direct link to Lay Summary Last update: 11.09.2017

Responsible applicant and co-applicants

Employees

Publications

Publication
Association of in-hospital multimorbidity with healthcare outcomes in Swiss medical inpatients
Magdalena Mueller, Monika Huembelin, Ciril Baechli, Ulrich Wagner, Philipp Schuetz, Beat Mueller, Alexander Kutz (2021), Association of in-hospital multimorbidity with healthcare outcomes in Swiss medical inpatients, in Swiss Medical Weekly, 151(5-6), 1-11.
The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study.
Koch Daniel, Kutz Alexander, Conca Antoinette, Wenke Juliane, Schuetz Philipp, Mueller Beat (2020), The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study., in Journal of advanced nursing, 76(12), 3483-3494.
Association of functional status and hospital-acquired functional decline with 30-day outcomes in medical inpatients: A prospective cohort study.
Koch Daniel, Kutz Alexander, Haubitz Sebastian, Baechli Ciril, Gregoriano Claudia, Conca Antoinette, Volken Thomas, Schuetz Philipp, Mueller Beat (2020), Association of functional status and hospital-acquired functional decline with 30-day outcomes in medical inpatients: A prospective cohort study., in Applied nursing research : ANR, 54, 151274-151274.
Improving the post-acute care discharge score (PACD) by adding patients' self-care abilities: A prospective cohort study.
Koch Daniel, Schuetz Philipp, Haubitz Sebastian, Kutz Alexander, Mueller Beat, Weber Helen, Regez Katharina, Conca Antoinette, Conca Antoinette (2019), Improving the post-acute care discharge score (PACD) by adding patients' self-care abilities: A prospective cohort study., in PloS one, 14(3), 0214194-0214194.
Integrative hospital treatment in older patients to benchmark and improve outcome and length of stay - the In-HospiTOOL study.
Kutz Alexander, Koch Daniel, Conca Antoinette, Baechli Ciril, Haubitz Sebastian, Regez Katharina, Schild Ursula, Caldara Zeljka, Ebrahimi Fahim, Bassetti Stefano, Eckstein Jens, Beer Juerg, Egloff Michael, Kaplan Vladimir, Ehmann Tobias, Hoess Claus, Schaad Heinz, Wagner Ulrich, de Geest Sabina, Schuetz Philipp, Mueller Beat (2019), Integrative hospital treatment in older patients to benchmark and improve outcome and length of stay - the In-HospiTOOL study., in BMC health services research, 19(1), 237-237.
SwissDRG und nutzerorientierte Kennzahlen Zeit Bilanz zu ziehen
Kutz Alexander, Schuetz Philpp, Mller Beat (2019), SwissDRG und nutzerorientierte Kennzahlen Zeit Bilanz zu ziehen, in Schweizerische Ärztezeitung, 523-524.
Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients.
Kutz Alexander, Gut Lara, Ebrahimi Fahim, Wagner Ulrich, Schuetz Philipp, Mueller Beat (2019), Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients., in JAMA network open, 2(2), 188332-188332.
Verbessert eine pflegegeleitete Versorgung die Selbstpflegefähigkeiten? Eine quasi‐experimentelle Studie
Wenke Juliane (2017), Verbessert eine pflegegeleitete Versorgung die Selbstpflegefähigkeiten? Eine quasi‐experimentelle Studie, in Klinische Pföegeforschung, 3, 48-60.
Integrierte Patientenbetreuung, Innovationsprojekt vor dem Start
Kutz Alexander (2017), Integrierte Patientenbetreuung, Innovationsprojekt vor dem Start, in Competence, 26-27.
Querdenker erweitern den Horizont
Kutz Alexander (2017), Querdenker erweitern den Horizont, in Clinicum, 22-29.

Collaboration

Group / person Country
Types of collaboration
Clinical Trial Unit (CTU), University of Basel (Prof. Christ-Crain) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
CISTEC AG Switzerland (Europe)
- Research Infrastructure
- Exchange of personnel
- Industry/business/other use-inspired collaboration
Department of Internal Medicine, University Hospital Basel (Prof. Basetti) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Swiss Forum for Managed Care Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel
MIVAG” (Masterplan Integrative Versorgung / eHealth Aargau (Herr Zanoni) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Höhere Fachschule Gesundheit und Soziales Aarau Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Exchange of personnel
Berner Bildungszentrum Pflege Switzerland (Europe)
- Publication
- Research Infrastructure
- Exchange of personnel

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
SGAIM Poster Impact of nation-wide implementation of DRG reimbursement on length of stay, readmission and mortality rates in medical inpatients in Switzerland 30.05.2018 Basel, Switzerland Regez Schüpbach Katharina; Kutz Alexander; Koch Daniel; Müller Beat; Schütz Philipp; Conca Antoinette; Zurfluh Seline;
9th international scientific congress for nursing and health care research Individual talk Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay – the In-HospiTOOL study 19.04.2018 St. Gallen, Switzerland Conca Antoinette; Müller Beat; Schütz Philipp; Regez Schüpbach Katharina; Kutz Alexander; Koch Daniel;
ENDO Annual Meeting Poster Impact of Diagnosis Related Groups (DRG) reimbursement on length of hospital stay and outcome measures in type 1 and type 2 diabetes patients 20.03.2018 Chicago, United States of America Schütz Philipp; Müller Beat; Kutz Alexander;
Tag der klinischen Forschung, Universitätsspital Basel Poster Impact of nation-wide implementation of DRG reimbursement on length of stay, readmission and mortality rates in medical inpatients in Switzerland 25.01.2018 Basel, Switzerland Kutz Alexander; Schütz Philipp; Müller Beat;
SGAIM Poster Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay – the In-HospiTOOL study 03.05.2017 Lausanne, Switzerland Kutz Alexander;
Versorgungsforschung in der Schweiz – wie weiter? Poster Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay – the In-HospiTOOL study 01.03.2017 Bern, Switzerland Koch Daniel; Caldara Zeljka; Regez Schüpbach Katharina; Kutz Alexander; Schütz Philipp; Zurfluh Seline; Conca Antoinette; Müller Beat;


Self-organised

Title Date Place
FMC Club 29.10.2018 Aarau, Switzerland
In-HospiTOOL Collaborative Key Person Meeting 30.01.2018 Aarau, Switzerland
Core Team Launch Event 20.01.2017 Aarau, Switzerland

Communication with the public

Communication Title Media Place Year
Print (books, brochures, leaflets) Kosten-Nutzen-Analyse interprofessioneller Zusammenarbeit im Gesundheitswesen Italian-speaking Switzerland Western Switzerland German-speaking Switzerland Rhaeto-Romanic Switzerland 2020
Talks/events/exhibitions Nice to have oder pädagogische Champions-League? German-speaking Switzerland 2020
Video/Film Interprofessionelle Zusammenarbeit am Beispiel In-HospiTOOL German-speaking Switzerland 2019
Video/Film In-HospiTOOL Studie International German-speaking Switzerland 2018
Media relations: print media, online media Versorgungsforschung, In-HospiTOOL Studie Mitarbeiterzeitschrift Kantonsspital Aarau German-speaking Switzerland 2017

Associated projects

Number Title Start Funding scheme
135222 Calcitonin Gene derived peptides for an Optimized Patient Transfer using an Innovative Multidisciplinary Assessment in the Canton Aargau (OPTIMA II) 01.04.2011 Project funding (Div. I-III)

Abstract

Health care costs in Switzerland are high and rising also due to the aging, polymorbid population. In-hospital treatment is key contributor to the current cost explosions. In view of the expected demographic evolution, resource allocation becomes a national priority. There is a lack of evidence-based tools namely for elderly, polymorbid patients to improve the integrative inter-professional in-hospital care and the transition process in real-life of an emergency and acute care hospital setting. Also, there is no reference standard for quality benchmarking in Switzerland which is mandatory to compare quality of different institutions. To address these issues, we propose a pragmatic multicenter “before-and-after” trial to study the effect of an inter-professional inpatient management tool (“In-HospiTOOL”) on length of stay and other patient outcomes. This tool combining several patient discharge measures was developed at our institution in an intensive multi-professional collaboration for the past ten years. For external multicenter validation of this tool, we will prospectively include consecutive polymorbid medical patients upon admission to the medical ward. Because patient-level randomization is not feasible for an intervention that focuses on the process of care, we will use a quasi-experimental approach and compare outcomes before and after hospital-wide implementation of the management tool. We will use time-trend analysis to compare length of stay before and after tool implementation. Data from other Swiss hospitals from the Swiss Federal Office of Health (Bundesamt für Gesundheit, BAG) serve as a control population. We target the inclusion of 45`000 patients over an 18-month period in at least five Swiss hospitals. The trial will inform us whether the “In-HospiTOOL” improves inter-professional team work and thereby reduces length of stay without negatively impacting subjective and objective markers of patient outcomes. The large amount of patient data collected within this trial will enable comparison of transition processes within different hospitals and establish a benchmarking for patient care quality addressing all three modules outlined by the “National Research Program” (NRP) 74 call. Our trial synergizes funds, national networks and, thus, will likely become a milestone in the current public healthcare discussions.
-