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Reforça't: A Community, Social, and Healthcare Program for Patients With Cardiorespiratory Conditions Upon Hospital Discharge

RecruitingNAAges 65 Years - anyAllCorporació de Salut del Maresme i la Selva
NCT06897410 on ClinicalTrials.gov ↗
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In plain words

What the trial is, and whether it could suit you

The goal of this randomized clinical trial is to determine whether an interdisciplinary, community-based intervention can reduce 30-day hospital readmissions and improve functional outcomes in patients aged 65 or older with chronic cardiac, respiratory, or mixed conditions following hospital discharge. The main questions it aims to answer are: Can the Reforça't program reduce 30-day hospital readmission rates to 25% compared to standard care? Does participation in Reforça't improve functional outcomes, medication adherence, quality of life, and mortality rates in this patient population? Researchers will compare patients enrolled in Reforça't (intervention group) with those receiving standard care (control group) to determine whether the program leads to lower readmission rates, improved health outcomes, and higher cost-effectiveness. Participants will: Undergo a pre- and post-inter

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📋 Eligibility rules (as published)
Inclusion Criteria: * Users admitted to the Polivalent Observation Units, Internal Medicine, or Hospital at home. * Individuals aged 65 years or older. * Hospital admission due to decompensation of a cardiac, respiratory, or mixed condition. * Place of residence within the health coverage area of Sant Jaume de Calella Hospital - Corporació de Salut del Maresme i la Selva. * Willingness to participate in the study as gathered by the signing of an informed consent document Exclusion Criteria: * Users institutionalized in a nursing home * Users already enrolled in home care programs * Users in the Advanced Chronic Care Model program with a limited life prognosis * Users on the waiting list for organ transplantation * Users with language barriers * Users with a GDS (Global Deterioration Scale) score of 5 or higher * Users who have already been included in the Reforça't program
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What it tests

  • Interdisciplinary Program for Post-Hospitalization / Hospital at home Management and Long-Term Outcomes in Older Adults with Chronic Cardiorespiratory Condition
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Where

1 site
Hospital Comarcal de Calella - Corporació de Salut del Maresme i la Selva
Calella, Spain
🤝 Taking part is your choice, and you can leave at any time. Only the trial team can confirm you are eligible — always decide together with your own doctor.
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