Clinical Assessment and Treatment in the Nursing Home as an Alternative to Hospital Admission

This multicenter, cluster-randomized, unblinded quality-improvement study evaluates whether home-based clinical assessment by municipal acute care teams can safely reduce hospital admissions among nursing home residents experiencing acute illness or clinical deterioration during out-of-hours periods. Participating nursing homes in the Capital Region of Denmark will be randomized to either usual care (contacting the regional medical helpline, 1813) or the intervention pathway, in which nursing home staff contact a municipal acute care team directly. The acute care team performs an on-site clinical assessment and, when needed, consults a senior physician in the hospital emergency department to establish a treatment and observation plan, which may include continued management at the nursing home under hospital responsibility. The study compares the intervention with usual care with respect to hospital admissions and mortality among nursing home residents.

Clusters (Nursing Homes): Inclusion Criteria: * Nursing homes, defined as long-term care facilities with care personnal available 24/7 for residents with need for continued medical care * Nursing homes located in the Capital Region of Denmark * Nursing homes accepting participation and cluster randomization Exclusion criteria * Assisted living facilities, intermediate/temporary care units, rehabilitation units, hospices, or other non-nursing-home setting. * Nursing homes located on the island of Bornholm