Community Assets Supporting Transitions (CAST) (CAST)

A Pragmatic Effectiveness-implementation Trial to Evaluate a Hospital-to-home Transitional Care Intervention Compared to Usual Care for Older Adults With Multiple Chronic Conditions and Depression

The aim of this study is to test a support program for older adults with symptoms of depression and other chronic health problems after they are discharged home from hospital. The study will be conducted in three communities in Ontario (Sudbury, Burlington, and Hamilton) and the program will be implemented with input from community members. The program will be delivered by a Registered Nurse, who will provide support to patients via home visits and telephone calls. The nurse's role will involve linking patients and their caregivers with needed services and supports, reviewing medications that the patients are taking, assessing patients' health, building the skills of patients in problem-solving and managing their care, and providing education to patients and their caregivers.

Study Overview

• Status: Completed
• Conditions: Depressive Symptoms; Comorbidity
• Intervention / Treatment: Behavioral: Intervention group (CAST)

Detailed Description

Implementing transitional care interventions for older adults with depressive symptoms and multiple chronic conditions (MCC) is a pressing concern since older adults with depression face persistent health disparities. The Community Assets Supporting Transitions (CAST) research team seeks to address these health inequities, and improve health outcomes in this vulnerable and under-served population by developing and implementing an intervention that will improve patients' self-management ability, support their families and caregivers, and build capacity for primary care and other health and non-health providers to collaborate in delivering home and community services. The proposed study builds on our pilot study that evaluated a nurse-led intervention for older adult home care clients with MCC and depressive symptoms and demonstrated that the intervention was feasible and effective in reducing depressive symptoms.

The overall aim of the study is to improve care transitions in older adults with MCC and depressive symptoms. The project will address three research questions:

1. What is the effect of a new, nurse-led hospital-to-home transitional care intervention compared to usual care on health outcomes and costs for older adults with MCC and depressive symptoms?
2. How is a care transition intervention adapted and implemented in diverse settings?
3. What is required to sustain and scale up the intervention? We hypothesize that the intervention will improve health outcomes and reduce use of expensive health services compared to usual care at no additional cost, from a societal perspective.

• Study Type: Interventional
• Enrollment (Actual): 127
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Burlington, Ontario, Canada
      • Joseph Brant Hospital
    • Hamilton, Ontario, Canada, L8L 2X2
      • Hamilton General Hospital
    • Hamilton, Ontario, Canada, L8N 3Z5
      • School of Nursing, McMaster University
    • Sudbury, Ontario, Canada
      • Health Sciences North/Laurentian University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Is an adult, age 65 or older;
• Is planned for discharge from hospital to the community (this includes retirement homes and transitional care beds);
• Self-reports having a diagnosis of at least two chronic conditions;
• Is experiencing depressive symptoms, assessed using the 2-item version of the Patient Health Questionnaire (PHQ-2);
• Lives within one of the study regions (Sudbury, Burlington, or Hamilton), and is not planning to move out of the region during the trial (defined as a one-year period);
• Is capable of providing informed consent, or has a substitute decision-maker who is able to provide informed consent on his/her behalf; and
• Is competent in English, or has an interpreter who is competent in English.

Exclusion Criteria:

• Is being discharged from the hospital to a long-term care home or tertiary care.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group (CAST); Participants in the intervention group will receive the CAST hospital-to-home transition intervention in addition to usual care.	Behavioral: Intervention group (CAST); Intervention duration is expected to be 6 months. A full-time registered nurse (RN) will function as a Care Transitions Coordinator (CTC) who works collaboratively with one local hospital and other health and non-health representatives to deliver the intervention, which includes: care coordination and system navigation (including facilitating timely primary care follow-up);; medication management;; assessing the needs and risk of the participants (including in-depth assessment of depressive symptoms);; evidence-based management of depressive symptoms and other chronic conditions to prevent the onset and worsening of other chronic conditions;; patient and caregiver education; and goal setting and problem-solving therapy.
No Intervention: Control group (usual care); Participants assigned to the control group will receive usual care at discharge from hospital to home.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in mental functioning of the older adult study participant	Measured by the mental component summary (MCS) score of the Veterans RAND 12 item Health Survey (VR-12).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in mental functioning of the family/friend caregiver of older adult participant (if applicable).	Measured by the mental component summary (MCS) score of the Veterans RAND 12 item Health Survey (VR-12).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization
Change in physical function of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	Measured by the physical component summary (PCS) score of the Veterans RAND 12 item Health Survey (VR-12).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization
Change in health-related quality of life of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	Measured by the Veterans RAND 12 item Health Survey (VR-12).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization
Change in depressive symptoms of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	As measured by the CESD-10 to determine the presence and severity of depressive symptoms.	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization
Change in anxiety of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	As measured by the GAD-7 (24).	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization
Change in caregiver strain of the family/friend caregiver of the older adult study participant (if applicable)	As measured by the Modified Caregiver Strain Index	T1 = Baseline data collection; TT2 = 6 months after randomization; T3 = 12 months after randomization
Change in utilization of health and social services by the: 1) older adult study participant, 2) family/friend caregiver of the older adult study participant.	As measured by the Health and Social Services Utilization Inventory	T1 = Baseline data collection; T2 = 6 months after randomization; T3 = 12 months after randomization
Change in utilization of health services by the older adult study participant	As identified through Institute for Clinical Evaluative Sciences (ICES) databases	T2 = 6 months after randomization; T3 = 12 months after randomization
Change in unmet care needs of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	As measured through the Unmet Care Needs questionnaire (developed using input from patient/caregiver co-researchers to ensure the inclusion of outcomes that are relevant and meaningful to patients and caregivers).	T1 = Baseline data collection; T2 = 6 months after randomization
Change in patient-provider communication of the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	As measured through the Patient-Provider Communication (PCC) questionnaire.	T1 = Baseline data collection; T2 = 6 months after randomization
Change in patient-reported experience (CCCQ) for the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	As measured through the adapted Client-Centred Care Questionnaired (CCCQ).	T1 = Baseline data collection; T2 = 6 months after randomization
Change in patient-reported experience (IC-PREMs) for the: 1) older adult study participant, 2) family/friend caregiver of older adult participant (if applicable).	As measured through the adapted Integrated Care Patient-Reported Experience Measures (IC-PREMs).	T1 = Baseline data collection; T2 = 6 months after randomization

Collaborators and Investigators

• Sponsor: McMaster University
• Collaborators: Canadian Institutes of Health Research (CIHR); Institute for Clinical Evaluative Sciences; Laurentian University; The Ontario Spor Support Unit; Labarge Optimal Aging Initiative
• Investigators: Principal Investigator: Carrie McAiney, Ph.D., University of Waterloo

Publications and helpful links

General Publications

• Markle-Reid M, McAiney C, Forbes D, Thabane L, Gibson M, Browne G, Hoch JS, Peirce T, Busing B. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms. BMC Geriatr. 2014 May 10;14:62. doi: 10.1186/1471-2318-14-62.
• Markle-Reid MF, McAiney C, Forbes D, Thabane L, Gibson M, Hoch JS, Browne G, Peirce T, Busing B. Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention. BMC Geriatr. 2011 Aug 25;11:50. doi: 10.1186/1471-2318-11-50.
• Markle-Reid M, McAiney C, Fisher K, Ganann R, Gauthier AP, Heald-Taylor G, McElhaney JE, McMillan F, Petrie P, Ploeg J, Urajnik DJ, Whitmore C. Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial. PLoS One. 2021 Jul 26;16(7):e0254573. doi: 10.1371/journal.pone.0254573. eCollection 2021.
• Markle-Reid M, McAiney C, Ganann R, Fisher K, Gafni A, Gauthier AP, Heald-Taylor G, McElhaney J, Ploeg J, Urajnik DJ, Valaitis R, Whitmore C. Study protocol for a hospital-to-home transitional care intervention for older adults with multiple chronic conditions and depressive symptoms: a pragmatic effectiveness-implementation trial. BMC Geriatr. 2020 Jul 10;20(1):240. doi: 10.1186/s12877-020-01638-0.

Helpful Links

• Aging, Community and Health Research Unit McMaster University
• Ontario SPOR support unit
• Canada Research Chair in Aging, Chronic Disease and Health Promotion Interventions

Study record dates

Study Major Dates

• Study Start (Actual): July 25, 2017
• Primary Completion (Actual): June 15, 2020
• Study Completion (Actual): June 15, 2020

Study Registration Dates

• First Submitted: April 12, 2017
• First Submitted That Met QC Criteria: May 16, 2017
• First Posted (Actual): May 17, 2017

Study Record Updates

• Last Update Posted (Actual): March 23, 2023
• Last Update Submitted That Met QC Criteria: March 21, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: Older Adults; Caregiver; Intervention; Transitional Care
• Additional Relevant MeSH Terms: Behavioral Symptoms; Depression
• Other Study ID Numbers: RFHSC 2000003756

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No