Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol, Stay@Home – Treat@Home

Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol, Stay@Home – Treat@Home | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol, Stay@Home – Treat@Home Doreen Müller, Deborah Elisabeth Jachan, Maria Stahl, Marie-Luise Rosenbusch, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4606482/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Dec, 2024 Read the published version in BMC Geriatrics → Version 1 posted 3 You are reading this latest preprint version Abstract Background Demographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care. Methods In this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. The study was planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology. Discussion Demographic change results in a larger elderly population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home – Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies. Trial registration: German Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered). outpatient care recipients telemedicine digital interactive health diary trans-sectoral care study protocol Figures Figure 1 Figure 2 Introduction Background Due to demographic changes, the number of outpatient care recipients is increasing nationwide in Germany. In the year 2050, approximately one in ten people in certain regions of Germany will be dependent on care (1). Four out of five are cared for at home, and more than half of them is 80 years or older (2). People who require care often experience impairment in their health and mobility (3). As a result, they require regular medical supervision but face greater challenges in accessing outpatient medical care, particularly specialist medical services (2). Another area of concern is the critical use of medication. Every 7th person in need of care receives a prescription for medication with associated risks. Additionally, polypharmacy is often a result of uncoordinated healthcare and more common among those in need of care, posing a risk of adverse drug interactions (2). Consequently, people who are care dependent rely on emergency services and inpatient care more frequently, resulting in a high number of unplanned and sometimes avoidable hospital admissions (4,5). On average, every care dependent person in Germany is hospitalized twice a year (2). Particularly among older care recipients with cognitive impairments, this exacerbates prognosis dramatically, leading to increased mortality, longer hospital stays, and a higher risk of rehospitalization (6–9). Furthermore, the transfer from home to the hospital can facilitate significant psychological distress for those affected, known as relocation stress or transfer trauma (10,11). Previous studies have shown that at least 30 percent of multimorbid care recipients in emergency departments would not require inpatient therapy if health changes were detected early on and timely medical assessment and treatment, for instance through telemedicine, could be arranged (12,13). Furthermore, interdisciplinary coordination of healthcare measures is beneficial for health outcomes. Objective The aim of the intervention is to provide continuous, needs-based, trans-sectoral and flexible healthcare for individuals receiving care at home during episodes of illness and health crises. Within the trans-sectoral care network established for this purpose, a new digital technology is intended to enable the rapid detection and communication of deteriorations in health status and facilitate early intervention in the home environment. The aim of this study is to assess whether the implementation of a telemedical supported trans-sectoral collaboration network can lead to a reduction in emergency situations and unplanned hospital admissions, improve state of health, quality of life, and care needs of individuals compared to standard care, and to evaluate the enhancement of interdisciplinary cooperation and usability facilitated by the new technology. Methods Design This is a prospective non-randomized complex intervention study with a pragmatic approach (14,15). Intervention The new form of healthcare Stay@Home – Treat@Home (STH) focuses on establishing an interdisciplinary and trans-sectoral network for low-threshold outpatient care in the home of care dependent individuals. This is facilitated through the digital interactive health diary, a telemedical application. Here, information about the participants' health status is collected by themselves, their caregivers, their general practitioner, and all stakeholders involved in acute care within the new form of healthcare and is accessible by them when needed (16). The new form of healthcare covers two areas of care: primary care as well as acute and emergency care. The primary care takes place as long as participants are in a stable health condition without acute care needs. Their health status is regularly recorded and reviewed by themselves, their caregivers, and their primary care physician within the digital interactive health diary. Acute and emergency care comes into play when regular entries in the digital interactive health diary enable the early detection of deteriorating health conditions. Initially, participants or their caregivers contact their general practitioner (GP), who then provides care to the participants as part of standard care. If the general practitioner is unreachable, participants call the medical on-call service of the Berlin Association of Statutory Health Insurance Physicians (KV Berlin) using a special hotline stored in the digital interactive health diary, thereby activating the care network. This triggers an STH event. The medical on-call service center determines the current care needs based on the symptoms of the patient/participant as well as her/his entries in the digital interactive health diary using the Structured Initial Medical Assessment in Germany (SmED) (17). The care pathways are outlined in figure 1. Figure 1: Care pathways of the new form of healthcare (simplified representation) STH event: event within the new form of healthcare; KV: Association of Statutory Health Insurance Physicians If immediate medical intervention is required, an emergency is triggered, the emergency medical services are alerted, and the STH event is terminated. If the case is not an emergency, and it is clearly determined that measure 1 or 2 is required, the event is passed on to the telemedical assistance. Otherwise, the medical on-call service of the association contacts the association's consulting physician, who then decides on further care for the participants. There are three possibilities: transfer of the case to standard care with simultaneous termination of the STH event (emergency use or referral to the hospital; light grey boxes in figure 1); closing of the case, as no acute assistance is necessary (white box in figure 1); or an intervention within the framework of the new form of healthcare (dark grey boxes in figure 1). Three types of interventions in the participants' home environment are provided: Measure 1 contains a general assistance provided by a nursing aid service without any further medical or nursing assistance. Measure 2 consists of nursing intervention offered by a nursing aid service or the participants' home care service. Measure 3 entails medical intervention facilitated by the medical on-call service, potentially combined with monitoring by a nursing aid service or remote treatment through the telemedical assistance. While the consulting physician directly assigns the task for measure 3 to the mobile medical on-call service of the association, measures 1 and 2 are controlled via the telemedical assistance, to which the consulting physician assigns the case. Additionally, during an STH event, the telemedical assistance can be utilized by all involved care providers at any time for consultative and coordinating activities. All stakeholders can also access information about the participants' health status in the digital interactive health diary, and all care steps are recorded by the stakeholders in the digital interactive health diary. Every STH event is reviewed and acknowledged by the participants' general practitioner, enabling therapy adjustments for the patients in the primary care setting, if necessary. Participants Assuming that the hospitalization rate in the patient group before the intervention is approximately 20 percent (2) with a potential of reduction to 15 percent during intervention (a reduction of 25 percent), with a power of 90 percent and a significance level of 0.05, the calculated sample size is 1,210 patients for the intervention group (18). To address sample attrition due to heightened mortality in the research group as well as other unforeseeable drop-outs, about 25 percent additional patients should be recruited, resulting in a total sample size of n = 1,500 participants in the intervention group, with at least the same number of controls to be drawn. GPs will be recruited through outreach by the KV, which in turn will recruit eligible participants for the study. The intervention group will be derived from eligible insurees of the participating health insurance companies, who are 60 years or older, reside in Berlin in their own home, receive support from a caregiver, and have been assessed as needing “care level” 1 or higher, or have applied for it. In Germany, five “care levels” represent a scale used to classify the level of care needed by individuals requiring long-term care. The respective care level determines the subsidies those individuals receive through their nursing care insurance provider. For the control group, insured individuals with similar characteristics to those in the intervention group will be identified from the enrollee and billing data of the participating health insurance companies. For better comparability, the aim is for the control group to also originate from Berlin, Germany. However, if the numbers are not sufficient, patients from structurally similar settlement areas will be included in the control group. A minimum 1:1 matching is planned, ensuring that the control group will be the same size as the intervention group. Depending on the number of insured individuals in the participating health insurance companies, a 1:n matching may also be performed, thereby increasing the size of the control group accordingly. Study period The study period was designed to take place within eight quarters (24 months). During the first six quarters (18 months), the intervention group will be gradually recruited for the new form of healthcare, so that individuals who are added at the end of the recruitment period can utilize the new form of healthcare for at least two quarters (6 months). For the control group and the operationalization of control variables, the claims data of the health insurance companies from a pre-observation period of eight quarters before entry into the new form of healthcare will be used. Figure 2 illustrates the planned data collection period and the cumulatively increasing sample size of the intervention group. Figure 2: Planned data collection periods. Data sources The data for the evaluation will be gathered from two main data sources. Firstly, various reports will be generated from the digital interactive health diary. These reports will encompass health-related basic data entered by participants, their caregivers, and their primary care physicians, such as current condition, diagnoses, therapies, medication plans, level of care needed, allergies, and measured vital parameters. Additionally, questionnaires for process evaluation and evaluation of health and quality of life will be collected via the digital interactive health diary. Furthermore, all event data for the STH event will be extracted through digital interactive health diary reports for the evaluation of utilization patterns and costs, as well as for process evaluation. As a second data source, data from the health insurance companies will be utilized (enrollee data, claims data concerning sick pay, nursing care, short-term care, outpatient and inpatient cases, ambulance services, prescription of medicinal products, medical devices, and aids). This will be used to establish the control group and to obtain data for comparing the new form of healthcare with standard care. The reports from the diary are continuously accessible in pseudonymized form by the evaluating parties. Each evaluation party receives only the data necessary for their specific research questions. For the evaluation utilization patterns and costs, it is necessary to merge the data from the diary with the enrollee and billing data from the health insurance companies. This is because treatments provided by the mobile medical on-call service within the framework of STH events are partly reimbursed and documented through STH project funds and partly through statutory health insurance. Outcomes Within the evaluation, three perspectives will be considered: health insurance, patients, and health care providers. All outcome variables are shown in table 1. Table 1: Outcomes Health insurance perspective On the level of the health insurance, utilization and total costs will be compared between intervention group and control group. Concerning utilization, number of hospital stays, days spent in inpatient hospital care, and number of emergency situations will be analyzed. For these measures, a second analysis will focus on ambulatory-care sensitive hospital stays and emergency responses (13,19). Furthermore, the volume of healthcare provided by the outpatient sector will be evaluated. For the economic evaluation, the total costs of the new form of healthcare in addition to costs for standard care within the intervention group will be assessed and compared to the cost of standard care for the control group (20–22). Patient perspective On the patient level, health, well-being, and care dependency will be evaluated in a pre-post-design, using data from the intervention group. Seven questions compiled on the basis of clinical experience will be used to assess general health. The participants of the intervention group will be asked weekly about falls, pain, urinary excretion, restlessness, shortness of breath, dizziness, and an open-ended question about any health problems experienced within the last seven days. The Quality of Life-Alzheimer’s Disease (QoL-AD) (23–26) is used to assess cognitive functioning in week 2-4 and 3-6 months after starting participation. Within 13 items, it covers physical health, energy, mood, living situation, memory, family, marriage, friends, chores, joy, money, own self, and life in general. Quality of life will be assessed using the Wellbeing measures in primary health care (WHO-5) questionnaire, containing five questions about mental well-being, like being in a good mood, feeling energetic, or being interested in daily life (27–29). The Oslo social support scale (OSSS-3) will be used to assess social support through three questions about relationships with close individuals and the availability of neighborly help (30,31). Moreover, the UCLA Loneliness Scale is added to measure loneliness within 20 items, evaluating topics like social isolation, companionship, and perceived social support (32). The WHO-5 questionnaire, OSSS-3 and the UCLA Loneliness Scale will be conducted in week 2-4 as well as 3-6 months after beginning to participate. Care dependency will be assessed using the Barthel-Index (33,34). Here, ten activities of daily living are assessed regarding the capability of conducting them independently. Participants will conduct the assessment in week 2-4 and 3-6 months after enrolment into the study. Health care provider perspective On the health care provider level, aspects concerning interdisciplinary cooperation, suitability for the task, and usability will be assessed. According to the cooperation model, successful interdisciplinary cooperation requires support for three subprocesses: coordination, communication, and knowledge integration (35). These topics will be evaluated using custom-designed questionnaires and interaction protocols derived from the diary. To assess interdisciplinary cooperation, interaction protocols are used to examine the content and timing of care during an STH event. For this purpose, all interactions of the respective stakeholders are recorded and stored by the digital interactive patient diary and analyzed using process mining methods (36). The analysis is initially carried out every 3 months. As the frequency of events increases, the evaluation is switched to monthly. Regarding the suitability/effectiveness of process and task integration, the adequacy of communication support among healthcare providers through the digital interactive health diary, and its facilitation of knowledge integration is evaluated using a questionnaire. Additionally, we will assess the extent to which the digital interactive health diary assists users in task execution (suitability for the task) using our own designed questions. These evaluations will focus on the timely detection of health status deviations, the accuracy of their urgency and relevance assessment, and the successful assistance of patients during emergencies. Every three months, every stakeholder (the patients, caregivers, and healthcare providers) will receive two questions on communication/knowledge integration and two questions on task appropriateness in the diary, which are adapted to their subtasks in the STH program. In addition, following an STH event, the stakeholders are asked to evaluate the course of care during an STH event. In case of a low rating, possible causes (text modules for selection and free text field) are recorded. The results will help us to identify possible weaknesses at an early stage and to rectify them promptly with suitable measures. The usability of the digital interactive health diary will be assessed quarterly using a tailored questionnaire by the German Social Accident Insurance Institution for the Health and Welfare services (BGW) (37). It evaluates suitability, ease of use, long-term adoption potential, workflow and technical adaptation, preference for healthcare with the digital interactive health diary, and clarity of screen content. Analysis Health insurance perspective Concerning the perspective of health insurance, the control group will be matched through propensity score matching, incorporating sociodemographic variables such as age, gender, level of care dependency, region, as well as morbidity and healthcare utilization in the 12 to 24 months prior to the study commencement. Analyses will focus on differences in the utilization of inpatient and emergency services between the intervention and control groups. Moreover, the study will assess ambulatory-sensitive utilization of inpatient and emergency services. Total costs for the new form of healthcare in addition to costs for standard care will be calculated and compared to the cost savings of standard care. The statistical analyses will be descriptive and inferential, with regression models selected based on data requirements. Additionally, a cost-effectiveness analysis will be conducted. Patient perspective For the analyses on the patient level, the development of general health, care dependency and well-being will be evaluated over the period of the study (pre-post-comparison) both descriptively and inferentially. Regression models will be selected based on data requirements. Age, female gender, and lower educational attainment (38) are associated with increased morbidity (39), thus these variables are included as covariates. Health care provider perspective The analysis from the health care provider perspective focuses on analyzing the (work) processes of the new form of healthcare, especially the processes during an STH event, and addresses issues relating (interdisciplinary) cooperation between stakeholders and the usability of the digital interactive health diary. Process mining techniques will be used to analyze the processes during an STH event as they take place. The results will be compared to the processes as they should be and will identify patterns, inefficiencies, and bottlenecks within the healthcare provider's operations (35). Descriptive methods will be used to analyze the data collected on (interdisciplinary) collaboration and usability. Discussion Demographic change leads to a larger population of older individuals and consequently more people facing mobility issues and care dependency. Furthermore, the shortage of nursing staff and other medical personnel will exacerbate the situation (40). New forms of care are needed to facilitate the work of healthcare providers and improve the health of care recipients. Advances in medicine and technology can help maintain or even improve the quality of life among the growing elderly population (41). With Stay@Home – Treat@Home, care dependent individuals can be monitored for health at home and provided medical services. Supported by a closely coordinated care network spanning both outpatient and inpatient sectors, and leveraging state-of-the-art technologies and telemedicine, the aim of the study is to evaluate whether this approach leads to a reduction in hospital admissions (42) and alleviate the burden on the healthcare system (43). The digital interactive health diary serves various functions. Firstly, it facilitates direct communication among patients, their caregivers, and healthcare providers. Regular entries related to health queries and measurements are guided and monitored by the GP. The GPs can access the health documentation stored by patients and caregivers at any time, allowing to remotely monitor the patient's condition. Secondly, patients and their caregivers can more easily detect any changes in health status themselves and take appropriate measures (44). Thirdly, should an intervention be necessary at the patient's home, personnel of nursing aid services as well as physicians can also access the entries to gain an understanding of the patient's health trajectory. They can document the measures they have taken, thereby providing a record of the course of events for all other healthcare providers involved. If the digital interactive health diary is to be included in regular standard care, it should not only be beneficial for the patients’ health and cost effective for health insurances. It also has to meet the needs of its direct users. In Germany, the documentation burden for healthcare providers is quite high (45). This is why this evaluation study considers not only the perspective of the patients and the health insurance, but also evaluates the experiences of the healthcare providers using this new digital interactive health diary (46). This way, Stay@Home – Treat@Home could potentially take a significant step forward in the advancement of medical and nursing care. Limitations The study will only be conducted in Berlin. Therefore, regional differences cannot be considered. Additionally, for ethical and practicality reasons, a randomized controlled trial could not be implemented. Strengths The strengths of the study include its high ecological validity, as this study is conducted under real world conditions within the frame of real healthcare services in Germany. Trial status Start of recruitment was March 25, 2024, and will continue until March 31, 2025. The observation period will end on September 30, 2025. By the time of submission (June 19, 2024), n= 6 participants have already been enrolled in the trial. Abbreviations BGW: German Social Accident Insurance Institution for the Health and Welfare services G-BA: German Federal Joint Committee GP: General practitioner KV: Association of Statutory Health Insurance Physicians OSSS-3: Oslo social support scale SmED: Structured Initial Medical Assessment in Germany STH: Stay@Home – Treat@Home QoL-AD: Quality of Life-Alzheimer’s Disease UCLA-LS: University of California Los Angeles-Loneliness Scale WHO-5: Wellbeing measures in primary health care Declarations Ethics approval and consent to participate The study received approval by the Ethics Committee of the Charité – Universitätsmedizin Berlin (ethics approval EA4/168/23). All participants in relation to the intervention group (intervention group patients, GPs, care givers) give written informed consent. Consent for publication Not applicable. Availability of data and materials The study data will not be publicly available as it contains potentially identifying as well as confidential patient data. Competing interests The authors declare that they have no competing interests. Funding This project Stay@Home – Treat@Home is funded by the Innovation Committee of the German Federal Joint Committee (G-BA) supported by the German Innovation Fund. Grant-ID: 01NVF21113. The funding body had no role in the design of the study, nor in the collection, analysis, or interpretation of study data, nor did they play a role in the writing of the manuscript or the submission of the manuscript for publication. Open Access funding enabled and organized by project DEAL. Authors’ Contributions MSch, DJ and NL were involved in the development of the evaluation concept. DM and DJ were the lead authors and wrote the first draft of the manuscript. MSt, MLR, PL, DLM, and NH made substantive additions to the manuscript. All authors read, critically revised, and approved the final version of the manuscript. Acknowledgements The authors would like to thank the entire STH study team/consortium as well as the patients and stakeholders involved in the new form of healthcare, without whom it would not have been possible to set up and implement the project. References Schwinger A, Klauber J, Tsiasioti C. Pflegepersonal heute und morgen. In: Jacobs K, Kuhlmey A, Greß S, Klauber J, Schwinger A, editors. Pflege-Report 2019: Mehr Personal in der Langzeitpflege - aber woher? [Internet]. Berlin, Heidelberg: Springer; 2020 [cited 2024 Apr 16]. p. 3–21. Available from: https://doi.org/10.1007/978-3-662-58935-9_1 Schwinger A, Jürchott K, Tsiasioti C, Matzk S, Behrendt S. Epidemiologie der Pflege: Prävalenz und Inanspruchnahme sowie die gesundheitliche Versorgung von Pflegebedürftigen in Deutschland. Bundesgesundheitsbl. 2023 May;66(5):479–89. Schulz M, Tsiasioti C, Czwikla J, Schwinger A, Gand D, Schmidt A, et al. 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Md State Med J. 1965 Feb;14:61–5. Heuschmann PU, Kolominsky-Rabas PL, Nolte CH, Hünermund G, Ruf HU, Laumeier I, et al. Untersuchung der Reliabilität der deutschen Version des Barthel-Index sowie Entwicklung einer postalischen und telefonischen Fassung für den Einsatz bei Schlaganfall-Patienten. Fortschr Neurol Psychiatr. 2005 Feb;73(2):74–82. Steinheider B, Legrady G. Kooperation in interdisziplinären Teams in Forschung, Produktentwicklung und Kunst. In: Oberquelle H, Oppermann R, Krause J, editors. Mensch & Computer 2001: 1 Fachübergreifende Konferenz [Internet]. Wiesbaden: Vieweg+Teubner Verlag; 2001 [cited 2024 Apr 23]. p. 37–46. Available from: https://doi.org/10.1007/978-3-322-80108-1_6 Van Der Aalst WMP, Weijters AJMM. Process mining: a research agenda. Computers in Industry. 2004 Apr;53(3):231–44. Müller L, Backhaus C. Entwicklung eines Fragebogens zur ergonomischen Bewertung von Medizinprodukten innerhalb des Beschaffungsprozesses in Gesundheitseinrichtungen. In: Analysieren, bewerten, gestalten: 65 Kongress der Gesellschaft für Arbeitswissenschaft. Dortmund: GfA-Press; 2019. OECD, Eurostat, UNESCO Institute for Statistics. ISCED 2011 Operational Manual: Guidelines for Classifying National Education Programmes and Related Qualifications [Internet]. OECD; 2015 [cited 2024 Mar 29]. Available from: https://www.oecd-ilibrary.org/education/isced-2011-operational-manual_9789264228368-en Zimmermann J, Brijoux T, Zank S. Erkrankungen, Pflegebedürftigkeit und subjektive Gesundheit im hohen Alter. In: Kaspar R, Simonson J, Tesch-Römer C, Wagner M, Zank S, editors. Hohes Alter in Deutschland [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2023 [cited 2024 Apr 16]. p. 63–87. (Schriften zu Gesundheit und Gesellschaft - Studies on Health and Society; vol. 8). Available from: https://link.springer.com/10.1007/978-3-662-66630-2_4 Rottländer R, Gehlen D, Hylla J, Tucman D. Pflege-Thermometer 2016: Eine bundesweite Befragung von Leitungskräften zur Situation der Pflege und Patientenversorgung in der ambulanten Pflege. Köln: Deutsches Institut für angewandte Pflegeforschung e.V. (dip); 2016. Klotz J. Steigende Lebenserwartung – länger gesund oder krank? In: Pinter G, Likar R, Schippinger W, Janig H, Kada O, Cernic K, editors. Geriatrische Notfallversorgung: Strategien und Konzepte [Internet]. Vienna: Springer; 2013 [cited 2024 Apr 16]. p. 13–24. Available from: https://doi.org/10.1007/978-3-7091-1581-7_2 Schuettig W, Sundmacher L. The impact of ambulatory care spending, continuity and processes of care on ambulatory care sensitive hospitalizations. Eur J Health Econ. 2022;23(8):1329–40. Bosch Health Campus [Internet]. [cited 2024 Apr 16]. Charité-Projekt gewinnt Gesundheitspreis Ideas for Impact. Available from: https://www.bosch-health-campus.de/de/presse/charite-projekt-gewinnt-gesundheitspreis-ideas-impact Schmiedhofer M, Möckel M, Slagman A, Frick J, Ruhla S, Searle J. Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites. BMJ Open. 2016 Nov 16;6(11):e013323. Kersting C, Herwig A, Weltermann B. Optimierungsbedarf bei Praxisverwaltungssystemen - Ergebnisse einer Fokusgruppe mit Hausärzten und MFA. Krick T, Huter K, Domhoff D, Schmidt A, Rothgang H, Wolf-Ostermann K. Digital technology and nursing care: a scoping review on acceptance, effectiveness and efficiency studies of informal and formal care technologies. BMC Health Serv Res. 2019 Jun 20;19(1):400. Tables Table 1: Outcomes Outcome Operationalization Data source Health insurance perspective Utilization: Hospital stays and emergency responses Number of hospital stays/ emergency responses Claims data Utilization: Ambulatory-care sensitive hospital stays and emergency responses Ambulatory-care sensitive diagnoses Claims data Utilization: ambulatory resource allocation Ambulatory medical utilization Claims data Cost: New form of healthcare All costs directed towards the new form of healthcare Diary and claims data Cost: Comparison of new form of healthcare versus standard care Comparison with saved costs of standard care Diary and claims data Patient perspective Health QoL-AD; own design of questions Diary data Well-being WHO-5; OSSS-3; UCLA-LS Diary data Care dependency Barthel-Index Diary data Healthcare provider perspective Interdisciplinary cooperation Own design of questions Diary data Suitability of tasks Own design of questions Diary data Usability BGW Diary data Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4606482","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":323151962,"identity":"485f9574-43ef-4c22-a8d9-5770e740144b","order_by":0,"name":"Doreen Müller","email":"","orcid":"","institution":"Central Research Institute of Ambulatory Health Care (Zi)","correspondingAuthor":false,"prefix":"","firstName":"Doreen","middleName":"","lastName":"Müller","suffix":""},{"id":323151963,"identity":"ce19e1fc-306c-4f7c-bb5d-53d16ef53326","order_by":1,"name":"Deborah Elisabeth 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14:14:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4606482/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4606482/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-024-05553-6","type":"published","date":"2024-12-02T15:58:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60599314,"identity":"ac520e83-fd0f-4cd9-8dcc-99c6c10f987e","added_by":"auto","created_at":"2024-07-18 15:57:03","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":95834,"visible":true,"origin":"","legend":"\u003cp\u003eCare pathways of the new form of healthcare (simplified representation)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSTH event: event within the new form of healthcare; KV: Association of Statutory Health Insurance Physicians\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4606482/v1/90adcd5e3a725ef08174f3a4.jpeg"},{"id":60599316,"identity":"b148a1db-d097-4857-b7f4-70ffc182260e","added_by":"auto","created_at":"2024-07-18 15:57:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22660,"visible":true,"origin":"","legend":"\u003cp\u003ePlanned data collection periods.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4606482/v1/06523a760a4c3c85632f57bc.png"},{"id":70964888,"identity":"d1d01397-f28f-45e2-a008-0676473d26e6","added_by":"auto","created_at":"2024-12-09 16:17:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":517281,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4606482/v1/93d8fe30-24aa-42fb-9d4d-10eba53c83f9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol, Stay@Home – Treat@Home","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cu\u003eBackground\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eDue to demographic changes, the number of outpatient care recipients is increasing nationwide in Germany. In the year 2050, approximately one in ten people in certain regions of Germany will be dependent on care\u0026nbsp;(1). Four out of five are cared for at home, and more than half of them is 80 years or older\u0026nbsp;(2). People who require care often experience impairment in their health and mobility\u0026nbsp;(3). As a result, they require regular medical supervision but face greater challenges in accessing outpatient medical care, particularly specialist medical services\u0026nbsp;(2). Another area of concern is the critical use of medication. Every 7th person in need of care receives a prescription for medication with associated risks. Additionally, polypharmacy is often a result of uncoordinated healthcare and more common among those in need of care, posing a risk of adverse drug interactions\u0026nbsp;(2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsequently, people who are care dependent rely on emergency services and inpatient care more frequently, resulting in a high number of unplanned and sometimes avoidable hospital admissions\u0026nbsp;(4,5). On average, every care dependent person in Germany is hospitalized twice a year\u0026nbsp;(2). Particularly among older care recipients with cognitive impairments, this exacerbates prognosis dramatically, leading to increased mortality, longer hospital stays, and a higher risk of rehospitalization\u0026nbsp;(6\u0026ndash;9). Furthermore, the transfer from home to the hospital can facilitate significant psychological distress for those affected, known as relocation stress or transfer trauma\u0026nbsp;(10,11).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that at least 30 percent of multimorbid care recipients in emergency departments would not require inpatient therapy if health changes were detected early on and timely medical assessment and treatment, for instance through telemedicine, could be arranged\u0026nbsp;(12,13). Furthermore, interdisciplinary coordination of healthcare measures is beneficial for health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eObjective\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of the intervention is to provide continuous, needs-based, trans-sectoral and flexible healthcare for individuals receiving care at home during episodes of illness and health crises. Within the trans-sectoral care network established for this purpose, a new digital technology is intended to enable the rapid detection and communication of deteriorations in health status and facilitate early intervention in the home environment. The aim of this study is to assess whether the implementation of a telemedical supported trans-sectoral collaboration network can lead to a reduction in emergency situations and unplanned hospital admissions, improve state of health, quality of life, and care needs of individuals compared to standard care, and to evaluate the enhancement of interdisciplinary cooperation and usability facilitated by the new technology.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cu\u003eDesign\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis is a prospective non-randomized complex intervention study with a pragmatic approach\u0026nbsp;(14,15).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eIntervention\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe new form of healthcare Stay@Home – Treat@Home (STH) focuses on establishing an interdisciplinary and trans-sectoral network for low-threshold outpatient care in the home of care dependent individuals. This is facilitated through the digital interactive health diary, a telemedical application. Here, information about the participants' health status is collected by themselves, their caregivers, their general practitioner, and all stakeholders involved in acute care within the new form of healthcare and is accessible by them when needed\u0026nbsp;(16). The new form of healthcare covers two areas of care: primary care as well as acute and emergency care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary care takes place as long as participants are in a stable health condition without acute care needs. Their health status is regularly recorded and reviewed by themselves, their caregivers, and their primary care physician within the digital interactive health diary.\u003c/p\u003e\n\u003cp\u003eAcute and emergency care comes into play when regular entries in the digital interactive health diary enable the early detection of deteriorating health conditions. Initially, participants or their caregivers contact their general practitioner (GP), who then provides care to the participants as part of standard care. If the general practitioner is unreachable, participants call the medical on-call service of the Berlin Association of Statutory Health Insurance Physicians (KV Berlin) using a special hotline stored in the digital interactive health diary, thereby activating the care network. This triggers an STH event. The medical on-call service center determines the current care needs based on the symptoms of the patient/participant as well as her/his entries in the digital interactive health diary using the Structured Initial Medical Assessment in Germany (SmED)\u0026nbsp;(17). The care pathways are outlined in figure 1.\u003c/p\u003e\n\u003cp\u003eFigure\u0026nbsp;1: Care pathways of the new form of healthcare (simplified representation)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSTH event: event within the new form of healthcare; KV: Association of Statutory Health Insurance Physicians\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIf immediate medical intervention is required, an emergency is triggered, the emergency medical services are alerted, and the STH event is terminated. If the case is not an emergency, and it is clearly determined that measure 1 or 2 is required, the event is passed on to the telemedical assistance. Otherwise, the medical on-call service of the association contacts the association's consulting physician, who then decides on further care for the participants. There are three possibilities: transfer of the case to standard care with simultaneous termination of the STH event (emergency use or referral to the hospital; light grey boxes in figure 1); closing of the case, as no acute assistance is necessary (white box in figure 1); or an intervention within the framework of the new form of healthcare (dark grey boxes in figure 1). Three types of interventions in the participants' home environment are provided: Measure 1 contains a general assistance provided by a nursing aid service without any further medical or nursing assistance. Measure 2 consists of nursing intervention offered by a nursing aid service or the participants' home care service. Measure 3 entails medical intervention facilitated by the medical on-call service, potentially combined with monitoring by a nursing aid service or remote treatment through the telemedical assistance.\u003c/p\u003e\n\u003cp\u003eWhile the consulting physician directly assigns the task for measure 3 to the mobile medical on-call service of the association, measures 1 and 2 are controlled via the telemedical assistance, to which the consulting physician assigns the case. Additionally, during an STH event, the telemedical assistance can be utilized by all involved care providers at any time for consultative and coordinating activities. All stakeholders can also access information about the participants' health status in the digital interactive health diary, and all care steps are recorded by the stakeholders in the digital interactive health diary. Every STH event is reviewed and acknowledged by the participants' general practitioner, enabling therapy adjustments for the patients in the primary care setting, if necessary.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eParticipants\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAssuming that the hospitalization rate in the patient group before the intervention is approximately 20 percent\u0026nbsp;(2)\u0026nbsp;with a potential of reduction to 15 percent during intervention (a reduction of 25 percent), with a power of 90 percent and a significance level of 0.05, the calculated sample size is 1,210 patients for the intervention group\u0026nbsp;(18). To address sample attrition due to heightened mortality in the research group as well as other unforeseeable drop-outs, about 25 percent additional patients should be recruited, resulting in a total sample size of n = 1,500 participants in the intervention group, with at least the same number of controls to be drawn. GPs will be recruited through outreach by the KV, which in turn will recruit eligible participants for the study. The intervention group will be derived from eligible insurees of the participating health insurance companies, who are 60 years or older, reside in Berlin in their own home, receive support from a caregiver, and have been assessed as needing “care level” 1 or higher, or have applied for it. In Germany, five “care levels” represent a scale used to classify the level of care needed by individuals requiring long-term care. The respective care level determines the subsidies those individuals receive through their nursing care insurance provider.\u003c/p\u003e\n\u003cp\u003eFor the control group, insured individuals with similar characteristics to those in the intervention group will be identified from the enrollee and billing data of the participating health insurance companies. For better comparability, the aim is for the control group to also originate from Berlin, Germany. However, if the numbers are not sufficient, patients from structurally similar settlement areas will be included in the control group. A minimum 1:1 matching is planned, ensuring that the control group will be the same size as the intervention group. Depending on the number of insured individuals in the participating health insurance companies, a 1:n matching may also be performed, thereby increasing the size of the control group accordingly.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStudy period\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe study period was designed to take place within eight quarters (24 months). During the first six quarters (18 months), the intervention group will be gradually recruited for the new form of healthcare, so that individuals who are added at the end of the recruitment period can utilize the new form of healthcare for at least two quarters (6 months). For the control group and the operationalization of control variables, the claims data of the health insurance companies from a pre-observation period of eight quarters before entry into the new form of healthcare will be used.\u0026nbsp;Figure 2\u0026nbsp;illustrates the planned data collection period and the cumulatively increasing sample size of the intervention group.\u003c/p\u003e\n\u003cp\u003eFigure\u0026nbsp;2: Planned data collection periods.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eData sources\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe data for the evaluation will be gathered from two main data sources. Firstly, various reports will be generated from the digital interactive health diary. These reports will encompass health-related basic data entered by participants, their caregivers, and their primary care physicians, such as current condition, diagnoses, therapies, medication plans, level of care needed, allergies, and measured vital parameters. Additionally, questionnaires for process evaluation and evaluation of health and quality of life will be collected via the digital interactive health diary. Furthermore, all event data for the STH event will be extracted through digital interactive health diary reports for the evaluation of utilization patterns and costs, as well as for process evaluation.\u003c/p\u003e\n\u003cp\u003eAs a second data source, data from the health insurance companies will be utilized (enrollee data, claims data concerning sick pay, nursing care, short-term care, outpatient and inpatient cases, ambulance services, prescription of medicinal products, medical devices, and aids). This will be used to establish the control group and to obtain data for comparing the new form of healthcare with standard care.\u003c/p\u003e\n\u003cp\u003eThe reports from the diary are continuously accessible in pseudonymized form by the evaluating parties. Each evaluation party receives only the data necessary for their specific research questions. For the evaluation utilization patterns and costs, it is necessary to merge the data from the diary with the enrollee and billing data from the health insurance companies. This is because treatments provided by the mobile medical on-call service within the framework of STH events are partly reimbursed and documented through STH project funds and partly through statutory health insurance.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOutcomes\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eWithin the evaluation, three perspectives will be considered: health insurance, patients, and health care providers. All outcome variables are shown in table 1.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1: Outcomes\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHealth insurance perspective\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOn the level of the health insurance, utilization and total costs will be compared between intervention group and control group. Concerning utilization, number of hospital stays, days spent in inpatient hospital care, and number of emergency situations will be analyzed. For these measures, a second analysis will focus on ambulatory-care sensitive hospital stays and emergency responses\u0026nbsp;(13,19). Furthermore, the volume of healthcare provided by the outpatient sector will be evaluated. For the economic evaluation, the total costs of the new form of healthcare in addition to costs for standard care within the intervention group will be assessed and compared to the cost of standard care for the control group\u0026nbsp;(20–22).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePatient perspective\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOn the patient level, health, well-being, and care dependency will be evaluated in a pre-post-design, using data from the intervention group. Seven questions compiled on the basis of clinical experience will be used to assess general health. The participants of the intervention group will be asked weekly about falls, pain, urinary excretion, restlessness, shortness of breath, dizziness, and an open-ended question about any health problems experienced within the last seven days. The\u0026nbsp;Quality of Life-Alzheimer’s Disease\u0026nbsp;(QoL-AD)\u0026nbsp;(23–26)\u0026nbsp;is used to assess cognitive functioning in week 2-4 and 3-6 months after starting participation. Within 13 items, it covers physical health, energy, mood, living situation, memory, family, marriage, friends, chores, joy, money, own self, and life in general.\u003c/p\u003e\n\u003cp\u003eQuality of life will be assessed using the\u0026nbsp;Wellbeing measures in primary health care\u0026nbsp;(WHO-5) questionnaire, containing five questions about mental well-being, like being in a good mood, feeling energetic, or being interested in daily life\u0026nbsp;(27–29). The\u0026nbsp;Oslo social support scale\u0026nbsp;(OSSS-3) will be used to assess social support through three questions about relationships with close individuals and the availability of neighborly help\u0026nbsp;(30,31). Moreover, the UCLA Loneliness Scale is added to measure loneliness within 20 items, evaluating topics like social isolation, companionship, and perceived social support\u0026nbsp;(32). The WHO-5 questionnaire, OSSS-3 and the UCLA Loneliness Scale will be conducted in week 2-4 as well as 3-6 months after beginning to participate.\u003c/p\u003e\n\u003cp\u003eCare dependency will be assessed using the Barthel-Index\u0026nbsp;(33,34). Here, ten activities of daily living are assessed regarding the capability of conducting them independently. Participants will conduct the assessment in week 2-4 and 3-6 months after enrolment into the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHealth care provider perspective\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOn the health care provider level, aspects concerning interdisciplinary cooperation, suitability for the task, and usability will be assessed. According to the cooperation model, successful interdisciplinary cooperation requires support for three subprocesses: coordination, communication, and knowledge integration\u0026nbsp;(35). These topics will be evaluated using custom-designed questionnaires and interaction protocols derived from the diary.\u003c/p\u003e\n\u003cp\u003eTo assess interdisciplinary cooperation, interaction protocols are used to examine the content and timing of care during an STH event. For this purpose, all interactions of the respective stakeholders are recorded and stored by the digital interactive patient diary and analyzed using process mining methods\u0026nbsp;(36). The analysis is initially carried out every 3 months. As the frequency of events increases, the evaluation is switched to monthly.\u003c/p\u003e\n\u003cp\u003eRegarding the suitability/effectiveness of process and task integration, the adequacy of communication support among healthcare providers through the digital interactive health diary, and its facilitation of knowledge integration is evaluated using a questionnaire. Additionally, we will assess the extent to which the digital interactive health diary assists users in task execution (suitability for the task) using our own designed questions. These evaluations will focus on the timely detection of health status deviations, the accuracy of their urgency and relevance assessment, and the successful assistance of patients during emergencies. Every three months, every stakeholder (the patients, caregivers, and healthcare providers) will receive two questions on communication/knowledge integration and two questions on task appropriateness in the diary, which are adapted to their subtasks in the STH program. In addition, following an STH event, the stakeholders are asked to evaluate the course of care during an STH event. In case of a low rating, possible causes (text modules for selection and free text field) are recorded. The results will help us to identify possible weaknesses at an early stage and to rectify them promptly with suitable measures.\u003c/p\u003e\n\u003cp\u003eThe usability of the digital interactive health diary will be assessed quarterly using a tailored questionnaire by the\u0026nbsp;German Social Accident Insurance Institution for the Health and Welfare services\u0026nbsp;(BGW)\u0026nbsp;(37). It evaluates suitability, ease of use, long-term adoption potential, workflow and technical adaptation, preference for healthcare with the digital interactive health diary, and clarity of screen content.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAnalysis\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHealth insurance perspective\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConcerning the perspective of health insurance, the control group will be matched through propensity score matching, incorporating sociodemographic variables such as age, gender, level of care dependency, region, as well as morbidity and healthcare utilization in the 12 to 24 months prior to the study commencement. Analyses will focus on differences in the utilization of inpatient and emergency services between the intervention and control groups. Moreover, the study will assess ambulatory-sensitive utilization of inpatient and emergency services. Total costs for the new form of healthcare in addition to costs for standard care will be calculated and compared to the cost savings of standard care. The statistical analyses will be descriptive and inferential, with regression models selected based on data requirements. Additionally, a cost-effectiveness analysis will be conducted.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePatient perspective\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor the analyses on the patient level, the development of general health, care dependency and well-being will be evaluated over the period of the study (pre-post-comparison) both descriptively and inferentially. Regression models will be selected based on data requirements. Age, female gender, and lower educational attainment\u0026nbsp;(38)\u0026nbsp;are associated with increased morbidity\u0026nbsp;(39), thus these variables are included as covariates.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHealth care provider perspective\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis from the health care provider perspective focuses on analyzing the (work) processes of the new form of healthcare, especially the processes during an STH event, and addresses issues relating (interdisciplinary) cooperation between stakeholders and the usability of the digital interactive health diary. Process mining techniques will be used to analyze the processes during an STH event as they take place. The results will be compared to the processes as they should be and will identify patterns, inefficiencies, and bottlenecks within the healthcare provider's operations (35). Descriptive methods will be used to analyze the data collected on (interdisciplinary) collaboration and usability.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDemographic change leads to a larger population of older individuals and consequently more people facing mobility issues and care dependency. Furthermore, the shortage of nursing staff and other medical personnel will exacerbate the situation\u0026nbsp;(40). New forms of care are needed to facilitate the work of healthcare providers and improve the health of care recipients. Advances in medicine and technology can help maintain or even improve the quality of life among the growing elderly population\u0026nbsp;(41). With Stay@Home \u0026ndash; Treat@Home, care dependent individuals can be monitored for health at home and provided medical services. Supported by a closely coordinated care network spanning both outpatient and inpatient sectors, and leveraging state-of-the-art technologies and telemedicine, the aim of the study is to evaluate whether this approach leads to a reduction in hospital admissions\u0026nbsp;(42)\u0026nbsp;and alleviate the burden on the healthcare system\u0026nbsp;(43).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe digital interactive health diary serves various functions. Firstly, it facilitates direct communication among patients, their caregivers, and healthcare providers. Regular entries related to health queries and measurements are guided and monitored by the GP. The GPs can access the health documentation stored by patients and caregivers at any time, allowing to remotely monitor the patient\u0026apos;s condition. Secondly, patients and their caregivers can more easily detect any changes in health status themselves and take appropriate measures\u0026nbsp;(44). Thirdly, should an intervention be necessary at the patient\u0026apos;s home, personnel of nursing aid services as well as physicians can also access the entries to gain an understanding of the patient\u0026apos;s health trajectory. They can document the measures they have taken, thereby providing a record of the course of events for all other healthcare providers involved.\u003c/p\u003e\n\u003cp\u003eIf the digital interactive health diary is to be included in regular standard care, it should not only be beneficial for the patients\u0026rsquo; health and cost effective for health insurances. It also has to meet the needs of its direct users. In Germany, the documentation burden for healthcare providers is quite high\u0026nbsp;(45). This is why this evaluation study considers not only the perspective of the patients and the health insurance, but also evaluates the experiences of the healthcare providers using this new digital interactive health diary\u0026nbsp;(46). This way, Stay@Home \u0026ndash; Treat@Home could potentially take a significant step forward in the advancement of medical and nursing care.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eLimitations\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe study will only be conducted in Berlin. Therefore, regional differences cannot be considered. Additionally, for ethical and practicality reasons, a randomized controlled trial could not be implemented.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStrengths\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe strengths of the study include its high ecological validity, as this study is conducted under real world conditions within the frame of real healthcare services in Germany.\u0026nbsp;\u003c/p\u003e"},{"header":"Trial status","content":"\u003cp\u003eStart of recruitment was March 25, 2024, and will continue until March 31, 2025. The observation period will end on September 30, 2025. By the time of submission (June 19, 2024), n= 6 participants have already been enrolled in the trial.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBGW: German Social Accident Insurance Institution for the Health and Welfare services\u003c/p\u003e\n\u003cp\u003eG-BA: German Federal Joint Committee\u003c/p\u003e\n\u003cp\u003eGP: General practitioner\u003c/p\u003e\n\u003cp\u003eKV: Association of Statutory Health Insurance Physicians\u003c/p\u003e\n\u003cp\u003eOSSS-3:\u0026nbsp;Oslo social support scale\u003c/p\u003e\n\u003cp\u003eSmED: Structured Initial Medical Assessment in Germany\u003c/p\u003e\n\u003cp\u003eSTH: Stay@Home \u0026ndash; Treat@Home\u003c/p\u003e\n\u003cp\u003eQoL-AD:\u0026nbsp;Quality of Life-Alzheimer\u0026rsquo;s Disease\u003c/p\u003e\n\u003cp\u003eUCLA-LS: University of California Los Angeles-Loneliness Scale\u003c/p\u003e\n\u003cp\u003eWHO-5: Wellbeing measures in primary health care\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe study received approval by the Ethics Committee of the Charit\u0026eacute; \u0026ndash; Universit\u0026auml;tsmedizin Berlin (ethics approval EA4/168/23). All participants in relation to the intervention group (intervention group patients, GPs, care givers) give written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe study data will not be publicly available as it contains potentially identifying as well as confidential patient data.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis project Stay@Home \u0026ndash; Treat@Home is funded by the Innovation Committee of the German Federal Joint Committee (G-BA) supported by the German Innovation Fund. Grant-ID:\u0026nbsp;01NVF21113.\u003c/p\u003e\n\u003cp\u003eThe funding body had no role in the design of the study, nor in the collection, analysis, or interpretation of study data, nor did they play a role in the writing of the manuscript or the submission of the manuscript for publication. Open Access funding enabled and organized by project DEAL.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthors\u0026rsquo; Contributions\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eMSch, DJ and NL were involved in the development of the evaluation concept. DM and DJ were the lead authors and wrote the first draft of the manuscript. MSt, MLR, PL, DLM, and NH made substantive additions to the manuscript. All authors read, critically revised, and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgements\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the entire STH study team/consortium as well as the patients and stakeholders involved in the new form of healthcare, without whom it would not have been possible to set up and implement the project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchwinger A, Klauber J, Tsiasioti C. Pflegepersonal heute und morgen. In: Jacobs K, Kuhlmey A, Gre\u0026szlig; S, Klauber J, Schwinger A, editors. Pflege-Report 2019: Mehr Personal in der Langzeitpflege - aber woher? [Internet]. Berlin, Heidelberg: Springer; 2020 [cited 2024 Apr 16]. p. 3\u0026ndash;21. Available from: https://doi.org/10.1007/978-3-662-58935-9_1\u003c/li\u003e\n\u003cli\u003eSchwinger A, J\u0026uuml;rchott K, Tsiasioti C, Matzk S, Behrendt S. 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Mensch \u0026amp; Computer 2001: 1 Fach\u0026uuml;bergreifende Konferenz [Internet]. Wiesbaden: Vieweg+Teubner Verlag; 2001 [cited 2024 Apr 23]. p. 37\u0026ndash;46. Available from: https://doi.org/10.1007/978-3-322-80108-1_6\u003c/li\u003e\n\u003cli\u003eVan Der Aalst WMP, Weijters AJMM. Process mining: a research agenda. Computers in Industry. 2004 Apr;53(3):231\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eM\u0026uuml;ller L, Backhaus C. Entwicklung eines Fragebogens zur ergonomischen Bewertung von Medizinprodukten innerhalb des Beschaffungsprozesses in Gesundheitseinrichtungen. In: Analysieren, bewerten, gestalten: 65 Kongress der Gesellschaft f\u0026uuml;r Arbeitswissenschaft. Dortmund: GfA-Press; 2019. \u003c/li\u003e\n\u003cli\u003eOECD, Eurostat, UNESCO Institute for Statistics. ISCED 2011 Operational Manual: Guidelines for Classifying National Education Programmes and Related Qualifications [Internet]. OECD; 2015 [cited 2024 Mar 29]. Available from: https://www.oecd-ilibrary.org/education/isced-2011-operational-manual_9789264228368-en\u003c/li\u003e\n\u003cli\u003eZimmermann J, Brijoux T, Zank S. Erkrankungen, Pflegebed\u0026uuml;rftigkeit und subjektive Gesundheit im hohen Alter. In: Kaspar R, Simonson J, Tesch-R\u0026ouml;mer C, Wagner M, Zank S, editors. Hohes Alter in Deutschland [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2023 [cited 2024 Apr 16]. p. 63\u0026ndash;87. (Schriften zu Gesundheit und Gesellschaft - Studies on Health and Society; vol. 8). Available from: https://link.springer.com/10.1007/978-3-662-66630-2_4\u003c/li\u003e\n\u003cli\u003eRottl\u0026auml;nder R, Gehlen D, Hylla J, Tucman D. Pflege-Thermometer 2016: Eine bundesweite Befragung von Leitungskr\u0026auml;ften zur Situation der Pflege und Patientenversorgung in der ambulanten Pflege. K\u0026ouml;ln: Deutsches Institut f\u0026uuml;r angewandte Pflegeforschung e.V. (dip); 2016. \u003c/li\u003e\n\u003cli\u003eKlotz J. Steigende Lebenserwartung \u0026ndash; l\u0026auml;nger gesund oder krank? In: Pinter G, Likar R, Schippinger W, Janig H, Kada O, Cernic K, editors. Geriatrische Notfallversorgung: Strategien und Konzepte [Internet]. Vienna: Springer; 2013 [cited 2024 Apr 16]. p. 13\u0026ndash;24. Available from: https://doi.org/10.1007/978-3-7091-1581-7_2\u003c/li\u003e\n\u003cli\u003eSchuettig W, Sundmacher L. The impact of ambulatory care spending, continuity and processes of care on ambulatory care sensitive hospitalizations. Eur J Health Econ. 2022;23(8):1329\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eBosch Health Campus [Internet]. [cited 2024 Apr 16]. Charit\u0026eacute;-Projekt gewinnt Gesundheitspreis Ideas for Impact. Available from: https://www.bosch-health-campus.de/de/presse/charite-projekt-gewinnt-gesundheitspreis-ideas-impact\u003c/li\u003e\n\u003cli\u003eSchmiedhofer M, M\u0026ouml;ckel M, Slagman A, Frick J, Ruhla S, Searle J. Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites. BMJ Open. 2016 Nov 16;6(11):e013323. \u003c/li\u003e\n\u003cli\u003eKersting C, Herwig A, Weltermann B. Optimierungsbedarf bei Praxisverwaltungssystemen - Ergebnisse einer Fokusgruppe mit Haus\u0026auml;rzten und MFA. \u003c/li\u003e\n\u003cli\u003eKrick T, Huter K, Domhoff D, Schmidt A, Rothgang H, Wolf-Ostermann K. Digital technology and nursing care: a scoping review on acceptance, effectiveness and efficiency studies of informal and formal care technologies. BMC Health Serv Res. 2019 Jun 20;19(1):400. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable\u0026nbsp;1: Outcomes\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperationalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\"\u003e\n \u003cp\u003e\u003cstrong\u003eData source\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth insurance perspective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eUtilization: Hospital stays and emergency responses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of hospital stays/ emergency responses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eClaims data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eUtilization: Ambulatory-care sensitive hospital stays and emergency responses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eAmbulatory-care sensitive diagnoses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eClaims data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eUtilization: ambulatory resource allocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eAmbulatory medical utilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eClaims data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eCost: New form of healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eAll costs directed towards the new form of healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eDiary and claims data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eCost: Comparison of new form of healthcare versus standard care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eComparison with saved costs of standard care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eDiary and claims data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient perspective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eHealth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eQoL-AD; own design of questions\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eDiary data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eWell-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eWHO-5; OSSS-3;\u0026nbsp;UCLA-LS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eDiary data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eCare dependency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eBarthel-Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eDiary data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare provider perspective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eInterdisciplinary cooperation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eOwn design of questions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eDiary data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eSuitability of tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eOwn design of questions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eDiary data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eUsability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.01023890784983%\" valign=\"top\"\u003e\n \u003cp\u003eBGW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.98976109215017%\" valign=\"top\"\u003e\n \u003cp\u003eDiary data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"outpatient care recipients, telemedicine, digital interactive health diary, trans-sectoral care, study protocol","lastPublishedDoi":"10.21203/rs.3.rs-4606482/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4606482/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDemographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. The study was planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eDemographic change results in a larger elderly population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home \u0026ndash; Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eGerman Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered).\u003c/p\u003e","manuscriptTitle":"Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol, Stay@Home – Treat@Home","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 15:56:57","doi":"10.21203/rs.3.rs-4606482/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-06-20T11:45:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-20T11:44:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-06-19T14:12:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b54973ce-d36c-46af-88fd-e519a27be972","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T16:07:21+00:00","versionOfRecord":{"articleIdentity":"rs-4606482","link":"https://doi.org/10.1186/s12877-024-05553-6","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2024-12-02 15:58:13","publishedOnDateReadable":"December 2nd, 2024"},"versionCreatedAt":"2024-07-18 15:56:57","video":"","vorDoi":"10.1186/s12877-024-05553-6","vorDoiUrl":"https://doi.org/10.1186/s12877-024-05553-6","workflowStages":[]},"version":"v1","identity":"rs-4606482","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4606482","identity":"rs-4606482","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}