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Trial registered on ANZCTR


Registration number
ACTRN12616000870459
Ethics application status
Approved
Date submitted
29/06/2016
Date registered
4/07/2016
Date last updated
1/11/2018
Date data sharing statement initially provided
1/11/2018
Date results information initially provided
1/11/2018
Type of registration
Prospectively registered

Titles & IDs
Public title
What factors influence discharge from General Medicine to Geriatric Evaluation and Management?
Scientific title
What factors influence discharge from General Medicine to Geriatric Evaluation and Management?
Secondary ID [1] 289509 0
Nil Known
Universal Trial Number (UTN)
U1111-1184-5025
Trial acronym
The FINDING Study
Linked study record

Health condition
Health condition(s) or problem(s) studied:
General Medical admission 299210 0
Hospital discharge 299211 0
Condition category
Condition code
Physical Medicine / Rehabilitation 299219 299219 0 0
Physiotherapy

Intervention/exposure
Study type
Observational
Patient registry
True
Target follow-up duration
3
Target follow-up type
Days
Description of intervention(s) / exposure
General medical patients often present with both clinical and functional problems and discharge planning often needs consideration of social dependency, and both physical and cognitive function.

Patients referred to Physiotherapy and admitted under a General Medical bed card and at the Royal Melbourne Hospital will be prospectively screened for inclusion into this study. The following data will be collected on 480 patients:
- Patient Demographics (age, gender, language spoken, co-morbidities, social situation and social supports)
- Medical information: (principle diagnosis, medications, visual and or hearing deficits)
- The Blaylock Risk Assessment Screening Score (BRASS) - an index used to predict patients who are at risk for prolonged hospital stay and need for discharge planning
- The de Morton Mobility Index (DEMMI) - a reliable and valid interval level index that accurately measures mobility levels in older acute medical patients
- The Alpha Functional Independence Measure (AlphaFIM): A standardised functional measure which covers mobility and cognitive domains
- The Rowland Universal Dementia Assessment Scale (RUDAS): A valid and reliable measure of cognition
- Number of falls in the past six months
- Number of previous hospital admissions in the past three months
Intervention code [1] 295188 0
Not applicable
Comparator / control treatment
No control group
Control group
Uncontrolled

Outcomes
Primary outcome [1] 298696 0
Discharge Destination as given by the hospital data management system, iPM
Timepoint [1] 298696 0
At discharge from General Medical bed card
Secondary outcome [1] 324988 0
Premorbid functional status assessed using the Blaylock Risk Assessment Screening Score (BRASS)
Timepoint [1] 324988 0
Within 72 hours of initial Physiotherapy contact
Secondary outcome [2] 324989 0
In-hospital mobility assessed using the de Morton Mobility Index (DEMMI)
Timepoint [2] 324989 0
Within 72 hours of initial Physiotherapy contact
Secondary outcome [3] 324990 0
In-hospital functional status using the Alpha Functional Independence Measure (AlphaFIM)Scores
Timepoint [3] 324990 0
Within 72 hours of initial Physiotherapy contact
Secondary outcome [4] 324991 0
In-hospital cognition using the Rowland Universal Dementia Assessment Scale (RUDAS)
Timepoint [4] 324991 0
Within 72 hours of initial Physiotherapy contact

Eligibility
Key inclusion criteria
- Patients referred to Physiotherapy and admitted under General Medical units, including those “outliers” on wards outside of the General Medical wards at the Royal Melbourne Hospital.
- Patients under a General Medical bed card but requiring ICU will be eligible once they are dis-charged to the ward as this is where discharge planning would typically commence.
Minimum age
18 Years
Maximum age
No limit
Gender
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
- Patients who are for palliation
- Patients already recruited who are readmitted
- Patients under 18 years of age
- Patients transferred from other units (including the Acute Medical and Short Stay Units) and who have already had Physiotherapy intervention will not be included.
- Similarly, patients who have had their initial Physiotherapy contact on the weekend or public holidays will not be included (including those patients transferred from ICU and seen on the ward on the weekend or public holiday). Patients admitted on the weekend or public holiday who have not had any physiotherapy intervention will remain appropriate to be included.

Study design
Purpose
Screening
Duration
Cross-sectional
Selection
Defined population
Timing
Prospective
Statistical methods / analysis
A pragmatic sample size of 480 is set for this study based on the ability to conduct this study feasibility during the study period. This sample size is sufficient for regression analyses and will allow the inclusion of a number of different dependent variables in the model. Data analysis will be undertaken using SPSS Windows Version 22.0.0 (SPSS, Chicago, IL, USA).

The independent variables, including patient demographics, home set up and supports (BRASS), pre-morbid mobility (DEMMI), current function (AlphaFIM) and cognition (RUDAS) data will be assessed for normality. Patient demographics, principle diagnosis and co-morbidities will be described and analysed descriptively. Logistic and linear regression will be used to examine relationships between independent variables and logistic regression will examine relationships between independent variables and discharge destination.

Independent t-tests, Chi-square tests and Mann-Whitney U will be used as appropriate to compare patients discharged to subacute versus other locations. Alpha is set at 0.05 for analyses.

Recruitment
Recruitment status
Completed
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
VIC
Recruitment hospital [1] 6005 0
Royal Melbourne Hospital - City campus - Parkville
Recruitment postcode(s) [1] 13427 0
3050 - Royal Melbourne Hospital

Funding & Sponsors
Funding source category [1] 293881 0
Hospital
Name [1] 293881 0
Royal Melbourne Hospital - Mary Elizabeth Watson Early Career Fellowship in Allied Health
Address [1] 293881 0
Royal Melbourne Hospital
300 Grattan St,
VIC
Parkville 3050
Country [1] 293881 0
Australia
Primary sponsor type
Individual
Name
Aruska D'Souza
Address
Royal Melbourne Hospital
300 Grattan St
Parkville, Victoria 3050
Country
Australia
Secondary sponsor category [1] 292709 0
None
Name [1] 292709 0
Address [1] 292709 0
Country [1] 292709 0
Other collaborator category [1] 279041 0
University
Name [1] 279041 0
University of Melbourne
Address [1] 279041 0
Royal Parade
Parkville, Victoria 3050
Country [1] 279041 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 295297 0
Royal Melbourne Hospital Quality Assurance Review
Ethics committee address [1] 295297 0
Royal Melbourne Hospital
300 Grattan St
Parkville, Victoria 3050
Ethics committee country [1] 295297 0
Australia
Date submitted for ethics approval [1] 295297 0
03/06/2016
Approval date [1] 295297 0
27/06/2016
Ethics approval number [1] 295297 0
QA2016059

Summary
Brief summary
Medical patients often present to hospital with both medical and functional problems, including social dependency, reduced mobility and cognitive impairment. As such, discharge planning forms an important part of a patient’s hospital stay. At present, an allied health team – consisting mainly of physiotherapists, occupational therapists, social workers, dieticians and speech pathologists – make recommendations for a discharge destination based on clinical experience. If the patient is not for discharge home they may require further allied health intervention at subacute. This process is potentially problematic when clinicians disagree on discharge destination. This can delay discharge and increase the patient’s length of stay. It can also detrimentally impact on the patient and family experience.

We hypothesis that deficits in mobility (both pre-admission and during admission), impaired cognition and inadequate social supports will be closely related to patients needing subacute on acute hospital discharge. There are a number of commonly used tools to measure such factors in the General Medical population. These include the de Morton Mobility Index (DEMMI) which has been used to assess mobility and predict discharge destination in this population, however, it has not considered the interplay of other factors. Other tools, such as the Alpha Functional Independence Measure (AlphaFIM), Charlson Co-morbidity Index (CCI), and the Blaylock Risk Assessment Screening Score (BRASS) and the Rowland Universal Dementia Screening Scale (RUDAS) have considered function, cognition, co-morbidities and social support but they have generally been used to assess current function, predict mortality and length of stay, rather than holistically determine the need for subacute. It is currently unknown which of these tools, when administered during an acute hospital stay, can best predict need for subacute.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 66810 0
Miss Aruska D'Souza
Address 66810 0
Royal Melbourne Hospital - City Campus
Level 4North Allied Health
300 Grattan Street,
Parkville, Victoria, 3050
Country 66810 0
Australia
Phone 66810 0
+61 3 9342 7000
Fax 66810 0
Email 66810 0
aruska.d'souza@mh.org.au
Contact person for public queries
Name 66811 0
Miss Aruska D'Souza
Address 66811 0
Royal Melbourne Hospital - City Campus
Level 4North Allied Health
300 Grattan Street,
Parkville, Victoria, 3050
Country 66811 0
Australia
Phone 66811 0
+61 3 9342 7000
Fax 66811 0
Email 66811 0
aruska.d'souza@mh.org.au
Contact person for scientific queries
Name 66812 0
Miss Aruska D'Souza
Address 66812 0
Royal Melbourne Hospital - City Campus
Level 4North Allied Health
300 Grattan Street,
Parkville, Victoria, 3050
Country 66812 0
Australia
Phone 66812 0
+61 3 9342 7000
Fax 66812 0
Email 66812 0
aruska.d'souza@mh.org.au

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
No/undecided IPD sharing reason/comment
What supporting documents are/will be available?
No other documents available
Summary results
Have study results been published in a peer-reviewed journal?
No
Other publications
Have study results been made publicly available in another format?
No
Results – basic reporting
Results – plain English summary