Navigation for Elderly People With Multiple Morbidity After Hospital Discharge.

Starting soon · Not applicable

Conditions studied: Multimorbidity

In brief

This research aims to create and test a tracking (navigation) model to assist in providing care guidance to elderly people (60 years or older) who have two or more chronic diseases at the same time (multimorbidity) immediately after being discharged from the hospital.

Key facts

Study ID

NCT07546006

Run by

Hospital de Clinicas de Porto Alegre

People needed

148

Starts

2026-06-01

Expected to finish

2028-03-30

Last updated by the study team

2026-04-22

Who can join

Age: 60 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Elderly individuals aged 60 or older;
• With confirmed multimorbidity documented in their medical records;
• Hospitalized in the SUS (Unified Health System) clinical units (5th North, 6th North, and 7th North), regardless of specialty;
• Who will be discharged home;
• Have telephone access and have a primary caregiver responsible for assisting with communication, in cases where the elderly person is unable to respond for themselves.

You may not qualify if…

• Elderly people hospitalized in restricted access clinical units (6th south), and those with private insurance or paying out-of-pocket (4th south);
• Those transferred to another hospital service or to other institutions;
• Patients who are already receiving or will receive navigation care or other safe discharge follow-up care;
• Patients in palliative care.

Where it is running

• Hospital de Clínicas de Porto Alegre — Porto Alegre, Rio Grande do Sul, Brazil

Full record on ClinicalTrials.gov

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