Skipping the Hospital: Acute Hospital Care at Home for People Living With Dementia
Brigham and Women's Hospital
Summary
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.
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
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 * I…
Interventions
- OtherAcute hospital care at home
Home visit for a serious illness conversation. Acute illness evaluation on demand. Acute hospital care at home as needed.
- OtherStandard medical treatment
Standard acute and emergency care delivered in a brick-and-mortar hospital setting.
Location
- Brigham and Women's HospitalBoston, Massachusetts