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Vaillantfonds","award":["20220809"],"award-info":[{"award-number":["20220809"]}]},{"name":"Wetenschapsfonds HagaZiekenhuis","award":["T22-066"],"award-info":[{"award-number":["T22-066"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Older adults with an acute moderate-to-severe lower respiratory tract infection (LRTI) or pneumonia are generally treated in hospitals causing risk of iatrogenic harm such as functional decline and delirium. These hospitalisations are often a consequence of poor collaboration between regional care partners, the lack of (acute) diagnostic and treatment possibilities in primary care, and the presence of financial barriers. We will evaluate the implementation of an integrated regional care pathway (\u2018The Hague RTI Care Bridge\u2019) developed with the aim to treat and coordinate care for these patients outside the hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>This is a prospective mixed methods study. Participants will be older adults (age\u226565 years) with an acute moderate-to-severe LRTI or pneumonia treated outside the hospital (care pathway group) versus those treated in the hospital (control group). In addition, patients, their informal caregivers and treating physicians will be asked about their experiences with the care pathway. The primary outcome of this study will be the feasibility of the care pathway, which is defined as the percentage of patients treated outside the hospital, according to the care pathway, whom fully complete their treatment without the need for hospitalisation within 30 days of follow-up. Secondary outcomes include the safety of the care pathway (30-day mortality and occurrence of complications (readmissions, delirium, falls) within 30 days); the satisfaction, usability and acceptance of the care pathway; the total number of days of bedridden status or hospitalisation; sleep quantity and quality; functional outcomes and quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>The Medical Research Ethics Committee Leiden The Hague Delft (reference number N22.078) has confirmed that the Medical Research Involving Human Subjects Act does not apply to this study. The results will be published in international peer-reviewed journals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"ISRCTN68786381\">ISRCTN68786381<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-073126","type":"journal-article","created":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T03:34:17Z","timestamp":1707968057000},"page":"e073126","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"isrctn68786381","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7611-5301","authenticated-orcid":false,"given":"Rick","family":"Roos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rianne M C","family":"Pepping","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten O","family":"van Aken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"Labots","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Lahdidioui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna M W","family":"van den Berg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki E","family":"Kolfschoten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharif M","family":"Pasha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris T","family":"ten Holder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M","family":"Mollink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederiek","family":"van den Bos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jojanneke","family":"Kant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Kroon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1074-6255","authenticated-orcid":false,"given":"Rimke C","family":"Vos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattijs E","family":"Numans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0734-0844","authenticated-orcid":false,"given":"Cees","family":"van Nieuwkoop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"key":"2024020708322986000_13.8.e073126.1","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.cger.2017.06.004","article-title":"Evaluation of Dyspnea in the elderly","volume":"33","author":"Mahler","year":"2017","journal-title":"Clin Geriatr Med"},{"key":"2024020708322986000_13.8.e073126.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2007.01428.x"},{"key":"2024020708322986000_13.8.e073126.3","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.7326\/L21-0615","article-title":"Is comprehensive geriatric assessment admission avoidance hospital at home an alternative to hospital admission for older persons?: a randomized trial","volume":"174","author":"Shepperd","year":"2021","journal-title":"Ann Intern Med"},{"key":"2024020708322986000_13.8.e073126.4","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1001\/jamainternmed.2018.2562","article-title":"Association of a bundled hospital-at-home and 30-day Postacute transitional care program with clinical outcomes and patient experiences","volume":"178","author":"Federman","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2024020708322986000_13.8.e073126.5","doi-asserted-by":"crossref","unstructured":"Gon\u00e7alves-Bradley DC , Iliffe S , Doll HA , et al . 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