Growing old at home - a randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826].
BACKGROUND
Regarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial.


METHODS
The trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session. The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160). Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective.


CONCLUSIONS
To the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.
Institute of Nursing and Health Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Germany. steffen.fleischer@medizin.uni-halle.de
Steffen
S
Fleischer
Gudrun
G
Roling
Katrin
K
Beutner
Stephanie
S
Hanns
Johann
J
Behrens
Tobias
T
Luck
Bettina
B
Kuske
Matthias C
MC
Angermeyer
Steffi G
SG
Riedel-Heller
Sven
S
Heinrich
Hans-H
HH
König
Christine
C
Lautenschläger
D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006299:Health Services for the Aged / Q000191:economics*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D009735:Nursing Homes / Q000191:economics*; D010343:Patient Admission / Q000191:economics* / Q000706:statistics & numerical data