Impact of Implementing a Real Time Frequent Admitter Risk Score (FAM-FACE-SG) on Readmission Rates (FAMFACESGRCT)

April 26, 2023 updated by: Singapore General Hospital

Impact of Implementing a Real Time Frequent Admitter Risk Score (FAM-FACE-SG) on Readmission Rates: a Pragmatic Cluster Randomised Controlled Trial (RCT).

In an earlier study using electronic health records (EHR), the investigators have identified nine factors to be significantly associated with FA risk. These nine predictors include Furosemide intravenous 40 milligrams or more; Admissions in the past one year; Medifund status; Frequent emergency department use; Anti-depressants treatment in past one year; Charlson comorbidity index; End Stage Renal Failure on dialysis; Subsidized ward stay and Geriatric patient. The investigators have combined these nine predictors into the FAM-FACE-SG score for FA risk (defined as 3 or more inpatient admissions in the following 12 months). The FAM-FACE-SG risk score has the advantage of being deployed in our hospital's enterprise data repository known as Electronic Health Intelligence System or eHINTs for short, on a real-time or near real-time basis. On a daily basis, data from multiple data sources are extracted, transformed and loaded onto the eHINTS system. The system can be programmed to run every midnight to provide risk scores the following morning for patients admitted the previous day.

In this trial, the intervention is to combine the FAM-FACE-SG risk score in addition to a decision making algorithm to guide referrals to various transitional care services based on needs assessment on nursing and function. The primary objective is to evaluate the impact of our intervention in improving healthcare utilization (hospital readmissions, emergency department (ED) attendances, length of stay up to 90 days post-discharge).

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

In an earlier study using electronic health records (EHR), The investigators have identified nine factors to be significantly associated with FA risk. These nine predictors include Furosemide intravenous 40 milligrams or more; Admissions in the past one year; Medifund status; Frequent emergency department use; Anti-depressants treatment in past one year; Charlson comorbidity index; End Stage Renal Failure on dialysis; Subsidized ward stay and Geriatric patient. The investigators have combined these nine predictors into the FAM-FACE-SG score for FA risk (defined as 3 or more inpatient admissions in the following 12 months). The FAM-FACE-SG risk score has the advantage of being deployed in our hospital's enterprise data repository known as Electronic Health Intelligence System or eHINTs for short, on a real-time or near real-time basis. On a daily basis, data from multiple data sources are extracted, transformed and loaded onto the eHINTS system. The system can be programmed to run every midnight to provide risk scores the following morning for patients admitted the previous day.

In this trial, the intervention is to combine the FAM-FACE-SG risk score in addition to a decision making algorithm to guide referrals to various transitional care services based on needs assessment on nursing and function. The primary objective is to evaluate the impact of our intervention in improving healthcare utilization (hospital readmissions, emergency department (ED) attendances, length of stay up to 90 days post-discharge).

The aims of this cluster RCT are to: (1) evaluate the impact of implementing the FAM-FACE-SG risk score in addition to a decision making algorithm to guide Patient Navigator (PN) referrals to various transitional care services based on needs assessment on nursing and function on improving healthcare utilization (hospital readmissions, emergency department (ED) attendances, length of stay up to 90 days post-discharge); (2) measure the implementation of the risk score (Fidelity of the PNs in adhering to the protocol in recruiting patients according the score priority; Referral rate of the PNs to various transitional care services; Qualitative feedback from PNs on the perceived benefits and behavior change after receiving the scores); (3) conduct an economic analysis of the cost-benefit of implementing the risk score.

Study Type

Interventional

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Singapore
      • Singapore, Singapore, 486838
        • Singapore General Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Singapore General Hospital wards with patient navigators
  • Patients who are frequent admitters (defined as 3 or more hospital admissions in the preceding 12 months)

Exclusion Criteria:

  • Haematology, Oncology, Emergency department, obstetrics and neonatology wards

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Control
Usual Care
Other: Control
- Usual hospital Care
Experimental: Intervention
FAM-FACE-SG risk score + decision making algorithm
Other: FAMFACESG
- PNs will receive the FAM-FACE-SG FA risk scores for frequent admitters admitted to their ward.
Other: FAMFACESG
- PNs will be instructed to prioritize intervention of frequent admitters for intervention based on the FA risk score.
Other: FAMFACESG
  • For high and moderate risk patients who do not require transitional home care (THC), PN will do the case management and follow up.
  • For high and moderate risk patients & have complex nursing and / or high functional needs, PNs will refer these patients for THC.
  • For mild risk patients, PNs will refer them to care coordinator.
Other: FAMFACESG
- For low risk patients, PNs will continue usual hospital care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
90-day readmission rate
Time Frame: 90 days
90 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
30-day readmission rate
Time Frame: 30 days
30 days
30-day ED attendance rate
Time Frame: 30 days
30 days
90-day ED attendance rate
Time Frame: 90 days
90 days
index hospital admission length of stay
Time Frame: 90 days
90 days
cumulative length of stay 90 days after index hospital discharge
Time Frame: 90 days
90 days
Fidelity of the PNs in following the protocol in recruiting patients according the score priority
Time Frame: 90 days
90 days
Proportion of high and medium risk patients recruited in both intervention and control groups
Time Frame: 90 days
90 days
Referral rate of the PNs to various transitional care services
Time Frame: 90 days
90 days
Qualitative feedback from PNs on the perceived benefits and behaviour change after receiving the scores
Time Frame: 1 year
Questionnaire survey
1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Singapore General Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

August 1, 2016

Primary Completion (Anticipated)

August 1, 2017

Study Completion (Anticipated)

August 1, 2017

Study Registration Dates

First Submitted

June 20, 2016

First Submitted That Met QC Criteria

June 23, 2016

First Posted (Estimate)

June 28, 2016

Study Record Updates

Last Update Posted (Actual)

April 28, 2023

Last Update Submitted That Met QC Criteria

April 26, 2023

Last Verified

April 1, 2023

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • SGH_OIC_FAMFACESG/5/2016

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Patient Readmission

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Algeria

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe