Acute Hospital Care at Home for People Living With Dementia

N/ANot Yet RecruitingNCT06819852

Brigham and Women's Hospital200 enrolled

Overview

The investigators will perform a parallel-group multicenter randomized controlled trial of a 1-year pre-enrolled acute hospital care at home intervention vs usual care for people living with dementia. Patients will be randomized only after eligibility determination and after the family caregiver agrees to enroll; people living with dementia will assent when able. Patients will be allocated in a concealed fashion to the control and intervention groups in randomly selected block sizes of 4 or 6 in 4 strata reflecting their functional status (activities of daily living: 0, 1, 2-3, 4-6). Although family and clinicians cannot be blinded, the investigators will blind the data collectors and assessors.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

200

Conditions

Emergency Department Visit Home Care Services Dementia

Interventions

Acute hospital care at homeOTHER

Home visit for a serious illness conversation. Acute illness evaluation on demand. Acute hospital care at home as needed.

Standard medical treatmentOTHER

Standard acute and emergency care delivered in a brick-and-mortar hospital setting.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of moderate or severe dementia (as ascertained by the Quick Dementia Rating System; QDRS) * Resides in a private or assisted living residence with or nearby (\<15min travel time) to a family caregiver * Resides within the Mass General Brigham (MGB) home hospital catchment area * Has had at least 1 hospitalization in the last 12 months. Exclusion Criteria: * No functioning utilities, such as no working heat (October-April), no running water, or no electricity. * Resides in skilled nursing facility * Resides in group home * Domestic violence screen positive * In police custody * Family caregiver unable to initiate or maintain communication with care team * End-stage renal disease on hemodialysis * On methadone requiring daily pickup of medication * Active substance use disorder, without functioning treatment plan * Psychiatric diagnosis that would prohibit successful home hospital care * Acute delirium without explanation or without the ability to manage at home * Patients with cancer requiring consistent hospital-based treatments * Cannot ambulate to bedside commode with assistance present in the home (if different from baseline), unless home-based aides are available

Outcomes

Primary Outcomes

Number of days at home

Sum of the number of days spent at home within the 30-days after an acute care episode

Time frame: Discharge to 30-days post discharge, up to 30 days

Secondary Outcomes

30-day unplanned readmission or mortality

Percentage of unplanned readmissions or mortality

Time frame: Discharge to 30-days post discharge, up to 30 days

Delirium

Percentage of days experiencing delirium while receiving acute care using the short confusion assessment method.

Time frame: Date of admission to date of discharge, estimated 5 days

Health-related quality of life

Absolute change of health-related quality of life over the year through the dementia quality of life survey (DEMQOL), or for patients unable to complete the survey, its proxy version (DEMQOL-Proxy).

Time frame: From enrollment for the period of one year

Physical activity

Percent of time sedentary as measured by patch monitoring system.