title: Impact of a transition nurse program on the prevention of thirty-day hospital readmissions of elderly patients discharged from short-stay units: study protocol of the PROUST stepped-wedge cluster randomised trial.
abstract: BACKGROUND
  In France, for patients aged 75 or older, it has been estimated that the hospital readmission rate within 30 days is 14 %, a quarter being avoidable. Some evidence suggests that interventions "bridging" the transition from hospital to home and involving a designated professional (usually nurses) are the most effective in reducing the risk of readmission, but the level of evidence of current studies is low. Our study aims to assess the impact of a care transition program from hospital to home for elderly admitted to short-stay units.
  
  
  METHODS
  This is a multicentre, stepped-wedge cluster randomised trial. The program will be implemented at three times of the transition: 1) during the patient's stay in hospital: development of a discharge plan, creation of a transitional care file, and notification of the primary care physician about inpatient care and hospital discharge by the transition nurse; 2) on the day of discharge: meeting between the transition nurse and the patient to review the follow-up recommendations; and 3) for 4 weeks after discharge: follow-up by the transition nurse. The primary outcome is the 30-day unscheduled hospital readmission or emergency visit rate after the index hospital discharge. The patients enrolled will be aged 75 or older, hospitalized in an acute care geriatric unit, and at risk of hospital readmission or an emergency visit after returning home. In all, 630 patients will be included over a 14-month period. Data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and patients will not be blinded.
  
  
  CONCLUSIONS
  Our study makes it possible to evaluate the specific effect of a bridging intervention involving a designated professional intervening before, during, and after hospital discharge. The strengths of the study design are methodological and practical. It permits the estimation of the intervention effect using between- and within-cluster comparisons; the study of the fluctuations in unscheduled hospital readmission or emergency visit rates; the participation of all clusters in the intervention condition; the implementation of the intervention in each cluster successively.
  
  
  BACKGROUND
  This study has been registered as a cRCT at clinicaltrials.gov (identifier: NCT02421133 ). Registered 9 March 2015.
authors.affiliation: Hospices Civils de Lyon, Unité de recherche sur la qualité et la sécurité des soins du Pôle Information Médicale Evaluation Recherche , Lyon, 69003, France. pauline.occelli@chu-lyon.fr.
authors.forename: Pauline
authors.initials: P
authors.lastname: Occelli
authors.affiliation: Hospices Civils de Lyon, Unité de recherche sur la qualité et la sécurité des soins du Pôle Information Médicale Evaluation Recherche , Lyon, 69003, France. sandrine.touzet@chu-lyon.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Touzet
authors.affiliation: Hospices Civils de Lyon, Service de Biostatistique, Lyon, 69003, France. muriel.rabilloud@chu-lyon.fr.|Université de Lyon, Lyon, 69000, France. muriel.rabilloud@chu-lyon.fr.|Université Lyon 1, Villeurbanne, 69100, France. muriel.rabilloud@chu-lyon.fr.|CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, 69100, France. muriel.rabilloud@chu-lyon.fr.
authors.forename: Muriel
authors.initials: M
authors.lastname: Rabilloud
authors.affiliation: Hospices Civils de Lyon, Unité de recherche sur la qualité et la sécurité des soins du Pôle Information Médicale Evaluation Recherche , Lyon, 69003, France. christell.ganne@chu-lyon.fr.
authors.forename: Christell
authors.initials: C
authors.lastname: Ganne
authors.affiliation: Hospices Civils de Lyon, Unité de recherche sur la qualité et la sécurité des soins du Pôle Information Médicale Evaluation Recherche , Lyon, 69003, France. stephanie.poupon-bourdy@chu-lyon.fr.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Poupon Bourdy
authors.affiliation: Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud - Pavillon Michel PERRET, Pierre-Bénite, 69495, France. beatrice.galamand@chu-lyon.fr.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Galamand
authors.affiliation: Centre Hospitalier Général d'Annecy, Pringy, 74374, France. mdebray@ch-annecygenevois.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Debray
authors.affiliation: Centre Hospitalier Alpes Léman, Contamine Sur Arve, 74130, France. adartiguepeyrou@ch-alpes-leman.fr.
authors.forename: André
authors.initials: A
authors.lastname: Dartiguepeyrou
authors.affiliation: Hôpital Édouard Herriot - Pavillon E, Lyon, 69003, France. michel.chuzeville@chu-lyon.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Chuzeville
authors.affiliation: Hôpital Édouard Herriot - Pavillon E, Lyon, 69003, France. brigitte.comte@chu-lyon.fr.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Comte
authors.affiliation: Clinique des Portes du Sud, Vénissieux, 69200, France. b.turkie@lesportesdusud.fr.
authors.forename: Basile
authors.initials: B
authors.lastname: Turkie
authors.affiliation: Centre Hospitalier de Saint-Chamond, Saint-Chamond, 42400, France. magali.tardy@hopitaldugier.fr.
authors.forename: Magali
authors.initials: M
authors.lastname: Tardy
authors.affiliation: Centre Hospitalier Gériatrique du Mont d'Or, Albigny-sur-Saône, 69250, France. js.luiggi@ch-montdor.fr.
authors.forename: Jean-Stéphane
authors.initials: JS
authors.lastname: Luiggi
authors.affiliation: CH Bourg en Bresse, Bourg-en-Bresse, 01012, France. tfrancillon@ch-bourg01.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Jacquet-Francillon
authors.affiliation: Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud - Pavillon Michel PERRET, Pierre-Bénite, 69495, France. thomas.gilbert@chu-lyon.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gilbert
authors.affiliation: Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud - Pavillon Michel PERRET, Pierre-Bénite, 69495, France. marc.bonnefoy@chu-lyon.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Bonnefoy
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000451:nursing* / Q000534:rehabilitation; D015403:Nursing Evaluation Research / Q000379:methods*; D010351:Patient Discharge / Q000639:trends*; D010359:Patient Readmission / Q000639:trends*; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors; D000069341:Transitional Care / Q000458:organization & administration*