ANZCTR - Registration

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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

11/11/2020

Date data sharing statement initially provided

1/11/2018

Date results provided

11/11/2020

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]

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

Hospital discharge

Condition category

Condition code

Physical Medicine / Rehabilitation

Physiotherapy

Intervention/exposure

Study type

Observational

Patient registry

True

Target follow-up duration

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]

Not applicable

Comparator / control treatment

No control group

Control group

Uncontrolled

Outcomes

Primary outcome [1]

Discharge Destination as given by the hospital data management system, iPM

Timepoint [1]

At discharge from General Medical bed card

Secondary outcome [1]

Premorbid functional status assessed using the Blaylock Risk Assessment Screening Score (BRASS)

Timepoint [1]

Within 72 hours of initial Physiotherapy contact

Secondary outcome [2]

In-hospital mobility assessed using the de Morton Mobility Index (DEMMI)

Timepoint [2]

Within 72 hours of initial Physiotherapy contact

Secondary outcome [3]

In-hospital functional status using the Alpha Functional Independence Measure (AlphaFIM)Scores

Timepoint [3]

Within 72 hours of initial Physiotherapy contact

Secondary outcome [4]

In-hospital cognition using the Rowland Universal Dementia Assessment Scale (RUDAS)

Timepoint [4]

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

Sex

Both males and females

Can healthy volunteers participate?

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

5/07/2016

Actual

5/07/2016

Date of last participant enrolment

Anticipated

28/04/2017

Actual

17/08/2017

Date of last data collection

Anticipated

Actual

17/08/2017

Sample size

Target

480

Accrual to date

Final

480

Recruitment in Australia

Recruitment state(s)

VIC

Recruitment hospital [1]

Royal Melbourne Hospital - City campus - Parkville

Recruitment postcode(s) [1]

3050 - Royal Melbourne Hospital

Funding & Sponsors

Funding source category [1]

Hospital

Name [1]

Royal Melbourne Hospital - Mary Elizabeth Watson Early Career Fellowship in Allied Health

Address [1]

Royal Melbourne Hospital
300 Grattan St,
VIC
Parkville 3050

Country [1]

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]

None

Name [1]

Address [1]

Country [1]

Other collaborator category [1]

University

Name [1]

University of Melbourne

Address [1]

Royal Parade
Parkville, Victoria 3050

Country [1]

Australia

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

Royal Melbourne Hospital Quality Assurance Review

Ethics committee address [1]

Royal Melbourne Hospital
300 Grattan St
Parkville, Victoria 3050

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

03/06/2016

Approval date [1]

27/06/2016

Ethics approval number [1]

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

Miss Aruska D'Souza

Address

Royal Melbourne Hospital - City Campus
Level 4North Allied Health
300 Grattan Street,
Parkville, Victoria, 3050

Country

Australia

Phone

+61 3 9342 7000

Fax

aruska.d'souza@mh.org.au

Contact person for public queries

Name

Aruska D'Souza

Address

Royal Melbourne Hospital - City Campus
Level 4North Allied Health
300 Grattan Street,
Parkville, Victoria, 3050

Country

Australia

Phone

+61 3 9342 7000

Fax

aruska.d'souza@mh.org.au

Contact person for scientific queries

Name

Aruska D'Souza

Address

Royal Melbourne Hospital - City Campus
Level 4North Allied Health
300 Grattan Street,
Parkville, Victoria, 3050

Country

Australia

Phone

+61 3 9342 7000

Fax

aruska.d'souza@mh.org.au

Data sharing statement

Will individual participant data (IPD) for this trial be available (including data dictionaries)?

No/undecided IPD sharing reason/comment

What supporting documents are/will be available?

No Supporting Document Provided

Results publications and other study-related documents

Documents added manually

No documents have been uploaded by study researchers.

Documents added automatically

No additional documents have been identified.

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