P4‐622: Dementia Hospital Care Research Programme: Peri‐operative Enhanced Recovery Hip Fracture Care of Patients With Dementia (perfected)—cluster Randomised Control Trial Results
Year: 2019
Type: article
Study design: Clinical Trial
Abstract: People admitted to acute hospital wards with physical illness/injury and cognitive impairments (CI) are complex with poorer outcomes. Evidence about how to improve care is lacking. PERFECT-ER is a new multi-component intervention developed with international stakeholders and designed to enhance recovery, being implemented at ward level, ensuring consistent delivery of multiple new and existing practices. The PERFECT-ER intervention is a multi-component service improvement intervention with a systematic implementation process. It comprises: (1) The PERFECT-ER checklist, (2) A Service Improve Lead (SIL), and (3) A model for change (plan-do-study act). This presentation describes the results of the clinical trial. A feasibility, multi-centre, cluster randomised clinical trial with integral qualitative evaluation was carried out. In line with MRC guidance for complex interventions, an integrated multi-method process evaluation was conducted and health economic data evaluation. The trial ran from (November 2016 – August 2018). Ethical approvals were gained from Camden and Kings Research Ethics Committee (04.07.2016, reference number: 16/LO/0621) and Scotland Research Ethics Committee A (28.06.2016, reference number: 16/SS/0086) accordingly. The trial was registered under ISRCTN 99336264. We recruited to the trial and implemented the intervention. We recruited 284 patients from 11 representative hospitals. PERFECT-ER had signals for improving cognition (MMSE) (1 point improvement) and in-patient hospital survival rate (1.5x higher). EQ5D Proxy was significantly better (p<0.05) at 3 and 6 months. From the process evaluation: despite difficulties in the acute hospital environment with staffing levels, bed pressures and numbers of frail patients, the intervention was welcomed and utilised in the intervention hospitals. Health economics data indicated that measures could be collected but there is significant complexity in the data processing. People admitted to hospital with hip and CI are vulnerable. Care reviews have shown some improvement in recognition of this issue, but communication and planning have repeatedly been found to be poor and in hospitals, training for staff is at best limited. PERFECTED is the largest trial to date in acute hospital care in CI and has shown that this intervention- PERFECT-ER can be implemented and has the potential to improve important outcomes. Further larger scale evaluation is required.
Source: Alzheimer s & Dementia
Language: English
Topic: Hip and Femur Fractures
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2981301536