Quality contract ‘prevention of postoperative delirium in the care of elderly patients’ study protocol: a non-randomised, pre–post, monocentric, prospective trial

Author:

Yürek FatimaORCID,Zimmermann Julian-DominicORCID,Weidner ElisaORCID,Hauß ArminORCID,Dähnert EnricoORCID,Hadzidiakos DanielORCID,Kruppa JochenORCID,Kiselev JoernORCID,Sichinava NatiaORCID,Retana Romero Oscar AndrésORCID,Hoff LaersonORCID,Mörgeli RudolfORCID,Junge Lennart,Scholtz KathrinORCID,Piper Sophie KORCID,Grüner LuzieORCID,Harborth Antonia Eva MariaORCID,Eymold Lisa,Gülmez Tuba,Falk Elke,Balzer FelixORCID,Treskatsch SaschaORCID,Höft MoritzORCID,Schmidt Dieter,Landgraf Franziska,Marschall UrsulaORCID,Hölscher Andreas,Rafii ManiORCID,Spies ClaudiaORCID

Abstract

IntroductionPostoperative delirium (POD) is seen in approximately 15% of elderly patients and is related to poorer outcomes. In 2017, the Federal Joint Committee (Gemeinsamer Bundesausschuss) introduced a ‘quality contract’ (QC) as a new instrument to improve healthcare in Germany. One of the four areas for improvement of in-patient care is the ‘Prevention of POD in the care of elderly patients’ (QC-POD), as a means to reduce the risk of developing POD and its complications.The Institute for Quality Assurance and Transparency in Health Care identified gaps in the in-patient care of elderly patients related to the prevention, screening and treatment of POD, as required by consensus-based and evidence-based delirium guidelines. This paper introduces the QC-POD protocol, which aims to implement these guidelines into the clinical routine. There is an urgent need for well-structured, standardised and interdisciplinary pathways that enable the reliable screening and treatment of POD. Along with effective preventive measures, these concepts have a considerable potential to improve the care of elderly patients.Methods and analysisThe QC-POD study is a non-randomised, pre–post, monocentric, prospective trial with an interventional concept following a baseline control period. The QC-POD trial was initiated on 1 April 2020 between Charité-Universitätsmedizin Berlin and the German health insurance company BARMER and will end on 30 June 2023. Inclusion criteria: patients 70 years of age or older that are scheduled for a surgical procedure requiring anaesthesia and insurance with the QC partner (BARMER). Exclusion criteria included patients with a language barrier, moribund patients and those unwilling or unable to provide informed consent. The QC-POD protocol provides perioperative intervention at least two times per day, with delirium screening and non-pharmacological preventive measures.Ethics and disseminationThis protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/054/20). The results will be published in a peer-reviewed scientific journal and presented at national and international conferences.Trial registration numberNCT04355195.

Funder

BARMER Health Insurance Company

Gemeinsame Bundesausschuss

Publisher

BMJ

Subject

General Medicine

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