Multicomponent telehealth care coordination: Participants randomised into the intervention group will be assigned a recovery navigator prior to discharge from hospital. The recovery navigator will provide the participant with a study tailored discharge summary, arrange the patients first appointment with their general practitioner and will ensure medications are reconciled prior to hospital discharge. The recovery coordinator will arrange weekly calls with the participant for the first 4 weeks and then fortnightly until week 12 to set recovery goals and assess recovery goals and navigator further primary care support if required. Participants will also be called at Day 90 and 180 by outcome assessors to collected patient reported outcomes.
Study summary
IMPROVE-65 is a randomised control trial designed specifically for people aged over 65 who have survived critical illness. It aims to support patients and general practitioners by providing timely, personalised information to help them work together to make informed goals and decisions about their care after hospital discharge. The aim of the study is to improve recovery and avoid preventable hospital readmissions.
Eligibility
Sex
ALL
Min age
65 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria:
* Was admitted to ICU for at least 48 hours
* is aged 65 years or older at the time of hospital admission
* Is alive and ready for hospital discharge
* Is expected to survive for 6 months beyond hospital discharge (e.g. not discharged on palliative care)
* Has new disability at hospital discharge measured using the global disability scale
Exclusion Criteria:
* Is not expected to reside in Australia for 3 months following randomisation.
* Is not expected to be living at home within 2 weeks of acute hospital discharge (e.g. prolonged inpatient rehabilitation)
* Is unable to identify a GP or GP clinic and/or are unable or unwilling to attend a GP appointment scheduled by the recovery navigator.
* Has an existing recovery or nurse navigator as part of their routine clinical care to assist with planning their care after hospital discharge
Primary outcome measure(s)
Hierarchical composite endpoint of death, avoidable hospital readmission and new global disability measured using the World Health Organisation Disability Schedule (WHODAS) 2.0 12L at 90 days after randomisation. — From randomisation until 90 days post randomisation. The hierarchical outcome of interest is a combination of out-of-hospital mortality, need for hospital readmission and WHODAS 2.0 score. The primary composite endpoint will be analysed using the win odds to account for ties.
Trial sites (2)
Facility
City
Region
Status
Cabrini Hospital Malvern
Melbourne
Victoria
Monash Health
Melbourne
Victoria
More Australian and New Zealand Intensive Care Research Centre trials in Australia
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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