A patient-held health-record for asylum-seekers in reception centres to improve continuity of care

INTERVENTION: The intervention consists of the introduction and routine use of a patient‐held health‐record (PHR) for asylum‐seekers in reception centres. The PHR is a paper‐based structured document (DIN A5) consisting of: a cover page with information for asylum‐seekers in 10 languages; information for the treating physicians; a flap to insert other documents (e.g. vaccination cards); a form for pre‐existing conditions; a medication plan; a form for reasons of encounter, assessment results, diagnoses and therapies; a form for vital parameters; and a personal schedule for appointments. Once the PHR is introduced, it is used continuously in the respective health care setting. The PHR will be introduced by cluster‐randomisation in a stepped wedge design in all reception centres in a large administrative area of the federal state of Baden‐Würrtemberg. The sequence of introducing the PHR is randomly determined at level of the reception centres (a total of five clusters). Allocation of clusters to the intervention remains concealed towards the authorities in charge of implementing the PHR. To allow for local preparations to introduce the PHR, authorities will be informed about the allocation of the randomly chosen reception centre towards the intervention 10 days in advance. The PHR will be introduced in 3‐week intervals, so that at the end of the study period the PHR will be introduced in all reception centres. Data will be collected for primary and secondary outcomes at the level of each patient‐physician encounter on specific dates of the week (+/‐ 2 days) determined by a random procedure. Due to the stepped wedge design, the number of follow‐ups in the post‐intervention period (i.e. after the PHR has been introduced) differs between reception centres, ranging from 12 weeks (reception centre in which the PHR was first introduced) to 3 weeks (last reception centre in which the PHR was introduced). Quantitative evaluation: Based on the turnover of patients in the reception centr CONDITION: The study does not focus on specific conditions ; Not Applicable PRIMARY OUTCOME: Prevalence of health‐related information in patient‐physician encounters, assessed by physician questionnaire throughout the whole evaluation period twice per week at randomly determined days (Monday to Friday +/‐ 2 days). Measurement occasions are chosen randomly using a simple random procedure. Time‐points for each measurement occasion remain concealed until the randomly chosen day and health care providers are not informed in advance of all measurement points. Sentinel practices are asked to measure the primary outcomes for each patient‐physician encounter with an asylum‐seeker during the 15 weeks. INCLUSION CRITERIA: Inclusion criteria for reception centres: The centres must provide health care services Inclusion criteria for physicians: Working in the reception centres Qualitative evaluation: Health professionals and asylum‐seekers (aged over 18) using the PHR SECONDARY OUTCOME: 1. Prevalence of "missing essential health‐related information"; 2. Physician satisfaction with the prevalence of health‐related information; ; Secondary outcomes will be measured throughout the whole evaluation period twice per week at randomly determined days (Monday to Friday +/‐ 2 days). Measurement occasions are chosen randomly using a simple random procedure. Secondary outcomes are measured at the level of patient‐physician encounters (physician‐rated measurement). Time‐points for each measurement occasion remain concealed until the randomly chosen day and health care providers are not informed in advance of all measurement points. Sentinel practices are asked to measure the secondary outcomes for each patient‐physician encounter with an asylum‐seeker during the 15 weeks.