THE DIVERT-CARE CATALYST TRIAL: TARGETED CHRONIC-DISEASE MANAGEMENT FOR HOME CARE CLIENTS

The pressure on our health-care system to deliver efficient, quality and cost-effective care is increasing. The debate on its sustainability is also expanding. These challenges can be managed with revisions to our health-care policy frameworks governing how and what public health-care services are delivered. Chronic disease management and home care can together ease many of the present and future pressures facing the health-care system. However, the current level of investment and the present policy are not effectively supporting movement in this direction. Updating the Canada Health Act to reflect the realities of our health-care system, and developing policies to support the areas of interdisciplinary teamwork and system integration are needed to facilitate chronic disease management and home care in Canada. This article lays out the challenges, highlights the impending issues and suggests a framework for moving forward.

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DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care

BMJ Open ◽

10.1136/bmjopen-2019-030301 ◽

2019 ◽

Vol 9 (12) ◽

pp. e030301 ◽

Cited By ~ 1

Author(s):

Andrew P Costa ◽

Connie Schumacher ◽

Aaron Jones ◽

Darly Dash ◽

Graham Campbell ◽

...

Keyword(s):

Chronic Disease ◽

Cost Effectiveness ◽

Action Research ◽

Disease Management ◽

Home Care ◽

Chronic Disease Management ◽

Management Model ◽

Care Providers ◽

Cluster Randomised ◽

The Difference

IntroductionHome care clients are increasingly medically complex, have limited access to effective chronic disease management and have very high emergency department (ED) visitation rates. There is a need for more appropriate and targeted supportive chronic disease management for home care clients. We aim to evaluate the effectiveness and preliminary cost effectiveness of a targeted, person-centred cardiorespiratory management model.Methods and analysisThe Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) — Collaboration Action Research and Evaluation (CARE) trial is a pragmatic, cluster-randomised, multicentre superiority trial of a flexible multicomponent cardiorespiratory management model based on the best practice guidelines. The trial will be conducted in partnership with three regional, public-sector, home care providers across Canada. The primary outcome of the trial is the difference in time to first unplanned ED visit (hazard rate) within 6 months. Additional secondary outcomes are to identify changes in patient activation, changes in cardiorespiratory symptom frequencies and cost effectiveness over 6 months. We will also investigate the difference in the number of unplanned ED visits, number of inpatient hospitalisations and changes in health-related quality of life. Multilevel proportional hazard and generalised linear models will be used to test the primary and secondary hypotheses. Sample size simulations indicate that enrolling 1100 home care clients across 36 clusters (home care caseloads) will yield a power of 81% given an HR of 0.75.Ethics and disseminationEthics approval was obtained from the Hamilton Integrated Research Ethics Board as well as each participating site’s ethics board. Results will be submitted for publication in peer-reviewed journals and for presentation at relevant conferences. Home care service partners will also be informed of the study’s results. The results will be used to inform future support strategies for older adults receiving home care services.Trial registration numberNCT03012256.

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Clinical interventions in home care

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0031 ◽

2017 ◽

pp. 223-228

Author(s):

Gideon Caplan

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Home Care ◽

Chronic Disease Management ◽

Controlled Trial ◽

Clinical Interventions ◽

Disease Management Programmes ◽

Healthcare Interventions ◽

Meta Analyses ◽

At Home

Healthcare interventions at home are vital for frail older people who frequently have difficulty accessing services. These clinical interventions include primary and secondary care, acute, subacute, and chronic disease management. Randomized controlled trial and meta-analyses have demonstrated improved health outcomes, such as decreased mortality, reduced hospitalization, and cost-effectiveness from many clinical interventions in home care, but not all. Hospital in the Home provides acute and subacute care at home across a wide range of diagnostic groups, whereas most chronic disease management programmes are disease specific. Improvements in and increased portability of technology has assisted many of these developments, but most home care remains proudly ‘high touch’. Ongoing improvements in technology hold the promise of greater benefits, but completely understanding the role of technological innovation in delivering improved outcomes cost effectively is a work in progress.

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