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  • Improving continuity of patient care across sectors: study protocol of the process evaluation of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)

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Health services research
Protocol
Improving continuity of patient care across sectors: study protocol of the process evaluation of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)
  1. Johanna Forstner1,
  2. Aline Kunz1,
  3. Cornelia Straßner1,
  4. Lorenz Uhlmann2,
  5. Stephanie Kuemmel3,
  6. Joachim Szecsenyi1,
  7. Michel Wensing1
  1. 1Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
  2. 2Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
  3. 3aQua-Institut GmbH, Göttingen, Germany
  1. Correspondence to Johanna Forstner; johanna.forstner{at}med.uni-heidelberg.de

Abstract

Introduction Hospital stays are critical events as they often disrupt continuity of care. This process evaluation aims to describe and explore the implementation of the VESPEERA programme (Improving continuity of patient care across sectors: An admission and discharge model in general practices and hospitals, Versorgungskontinuitaet sichern: Patientenorientiertes Einweisungs- und Entlassmanagement in Hausarztpraxen und Krankenhauesern). The evaluation concerns the intervention fidelity, reach in targeted populations, perceived effects, working mechanisms, feasibility, determinants for implementation, including contextual factors, and associations with the outcomes evaluation. The aim of the VESPEERA programme is the development, implementation and evaluation of a structured admission and discharge programme in general practices and hospitals.

Methods and analysis The process evaluation is linked to the VESPEERA outcomes evaluation, which has a quasi-experimental multi-centre design with four study arms and is conducted in hospitals and general practices in Germany. The VESPEERA programme comprises several components: an assessment before admission, an admission letter, a telephonic discharge conversation between hospital and general practice before discharge, discharge information for patients, structured planning of follow-up care after discharge in the general practice and a telephone monitoring for patients with a risk of rehospitalisation. The process evaluation has a mixed-methods design, incorporating interviews (patients, both care providers who do and do not participate in the VESPEERA programme, total n=75), questionnaires (patients and care providers who participate in the VESPEERA programme, total n=475), implementation plans of hospitals, data documented in general practices, claims-based data and hospital process data. Data analysis is descriptive and explorative. Qualitative data will be transcribed and analysed using framework analysis based on the Consolidated Framework for Implementation Research. Associations between the outcomes of the program and measures in the process evaluation will be explored in regression models.

Ethics and dissemination Ethics approval has been obtained by the ethics committee of the Medical Faculty Heidelberg prior to the start of the study (S-352/2018). Results will be disseminated through a final report to the funding agency, articles in peer-reviewed journals and conferences.

Trial registration number http://www.drks.de/DRKS00015183.

Trial status The study protocol on hand is the protocol V.1.1 from 18 June 2018. Recruitment for interviews started on 3 September 2018 and will approximately be completed by the end of May 2019.

  • process evaluation
  • CFIR
  • determinants for implementation
  • admission management
  • discharge management
  • continuity of care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-031245

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    Footnotes

    • Contributors JF, AK and MW drafted the original manuscript. CS, MW, JF, AK and JS have planned the study, planned the data collection and have designed all instruments for data collection. LU provided statistical expertise. SK is involved in data collection of patient data. All authors read and approved the final manuscript.

    • Funding This work was supported by the Federal Joint Committee (G-BA), Innovation Fund, grant number 01NVF17024.

    • Competing interests JS holds stocks of the aQua-Institut.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol has been submitted to and approved by the ethics committee of the Medical Faculty Heidelberg prior to the start of the study (S-352/2018).

    • Provenance and peer review Not commissioned; externally peer reviewed.