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. 2021 Sep 14;10(9):e31690.
doi: 10.2196/31690.

Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial

Jori E Fleisher  1 , Serena Hess  1 , Brianna J Sennott  1 , Erica Myrick  1   2 , Ellen Klostermann Wallace  1 , Jeanette Lee  1   3 , Maya Sanghvi  1   4 , Katheryn Woo  1 , Bichun Ouyang  5 , Jayne R Wilkinson  6   7 , James Beck  8 , Tricia J Johnson  9 , Deborah A Hall  1 , Joshua Chodosh  10   11
Affiliations

Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial

Jori E Fleisher et al. JMIR Res Protoc. .

Abstract

Background: The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization.

Objective: The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care.

Methods: In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage-matched control dyads drawn from US participants in the longitudinal Parkinson's Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination.

Results: The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway.

Conclusions: To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs.

Trial registration: ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459.

International registered report identifier (irrid): PRR1-10.2196/31690.

Keywords: caregiver; caregiver strain; home visits; homebound; interdisciplinary care; palliative care; quality of life; telehealth, Parkinson disease.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Interdisciplinary home visits for Parkinson disease study structure, visit flow, and discipline-specific responsibilities at each visit. MD: movement disorders specialist; RC: research co-ordinator; RN: nurse; SW: social worker; UPDRS: Unified Parkinson’s Disease Rating Scale.
Figure 2
Figure 2
Example of a follow-up phone call note for an interdisciplinary home visit for Parkinson disease in the electronic medical record using a standardized template. MD: movement disorders specialist; PCP: primary care provider; PD: Parkinson disease.
See this image and copyright information in PMC

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