Background

Many acutely ill and elderly people are currently often brought to the emergency room by ambulance and treated as inpatients for long periods of time. Short-term inpatient treatment followed by further outpatient treatment would be more medically appropriate.

The StatAMed project is establishing a new, interdisciplinary level of care as a bridge between outpatient practice and hospital. The aim is to provide short inpatient general medical care for (sub-)acute cases in structurally weak rural and urban regions. Through continuous coordination between all parties involved, unnecessary emergency admissions are avoided and patients can quickly return to their familiar surroundings after targeted, planned treatment.

The aim is to create a bridge between outpatient and inpatient treatment that enables low-threshold care with a short inpatient stay. This new form of care (NFV) is to consist of three phases: (1) recommendation of inpatient treatment, e.g. due to acute complaints and coordination of treatment goals between the StatAMed doctor in charge and the referring physician, (2) needs-based care during the (short) inpatient stay and (3) ensuring aftercare by supporting patient guides and nursing staff ("flying nurses") who continue to care for patients in their own homes. The aim of StatAMed is to intensify intersectoral and interdisciplinary cooperation. The NFV is being tested at three urban and three rural locations.

Objective

The scientific evaluation examines the StatAMed NFP at patient and organizational level as well as in the entire target population. The aim is to demonstrate the effectiveness, cost efficiency and diffusion processes of the intervention and to understand the organizational change. In addition, process-describing and organization-changing processes will be examined to optimize implementation. The combination of summative, formative and process evaluation provides a comprehensive picture of the impact and feasibility of the NVF StatAMed.

Research design / procedure

StatAMed is being investigated in a prospective, cluster-randomized study in a stepped-wedge design (SWD). As part of the summative evaluation, the effectiveness of the intervention with regard to the co-primary endpoint of length of stay and 30-day rehospitalization will be examined using routine SHI data. In the health economic evaluation, the cost-effectiveness of the NVF is analyzed from the perspective of the health insurance funds and presented as an incremental cost-effectiveness ratio (ICER). To this end, routine data on outpatient, inpatient, pharmaceutical, therapeutic and medical aid care as well as rehabilitation are evaluated, supplemented by the actual costs of the intervention. In parallel, the formative evaluation accompanies the implementation of the NVF over the duration of the study and examines mechanisms of action and effect-modifying factors, based on established methods for process evaluation of complex interventions. Different survey methods are used to comprehensively answer questions about context, recruitment, implementation, mechanisms of action and effectiveness.