Expanding Access to Comprehensive Geriatrics Care Via Telehealth (TeleGRACE)

Expanding Access to Comprehensive Geriatrics Care Via Telehealth (QUE 20-010)

The overall objective of the TeleGRACE project is to improve the care and outcomes of older Veterans with a recent inpatient stay by expanding access to the evidence-based GRACE program, by evaluating a telehealth implementation.

Study Overview

• Status: Terminated
• Conditions: Geriatric Syndrome
• Intervention / Treatment: Other: TeleGRACE

Detailed Description

The TeleGRACE evaluation will focus on three primary aims and a secondary aim:

Primary Aim 1: To examine the effectiveness of the TeleGRACE program, the investigators designed a randomized controlled implementation trial (RCT) powered for the primary outcome of 90-day all-cause mortality. The investigators will also examine its effectiveness for the secondary outcomes including 90-day readmissions, 1-year ED utilization (VA and non-VA), 1-year all-cause readmissions, 1-year mortality, as well as patient, caregiver, and staff satisfaction. The investigators hypothesize that patients who receive TeleGRACE will have lower 90-day mortality than patients in usual care.

Primary Aim 2: to examine the implementation of the TeleGRACE program. The implementation strategy is reflecting & evaluating. Implementation outcomes are based on the REAIM framework and include reach, efficacy (Aim 1), and implementation (total number of Veterans served, fidelity).

Primary Aim 3: to conduct a business-case analysis (BCA). The business case analysis will calculate the net financial savings or loss for TeleGRACE as the difference in the overall intervention costs and savings due to downstream benefits for patients receiving TeleGRACE versus usual care controls.

• Study Type: Interventional
• Enrollment (Actual): 111
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46202-2884
      • Richard L. Roudebush VA Medical Center, Indianapolis, IN

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 70 years and older (Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Veterans discharged from the Indianapolis VA medical center (VAMC) for an medical/surgical diagnosis (excludes substance use disorder-related admissions; excludes planned admissions) within the prior week
• Age 70 years
• Not enrolled in home-based primary care (HBPC)
• Not enrolled in hospice
• Not in dialysis
• Primary care visit within VA in the prior 2 years
• Not residing in nursing home, skilled nursing facility, or CLC.
• Living >20 miles but <60 miles from the Indianapolis VAMC facility
• CAN score 95th percentile for mortality or missing CAN score
• Discharged from the hospital alive

Exclusion Criteria:

• Patients who have been randomized to the control arm after their index hospitalization who become readmitted to the hospital may not be re-randomized.
• By definition, GRACE patients are not eligible for TeleGRACE due to the drive distance >20 miles from the Indianapolis VAMC
• Enrolled in home-based primary care (HBPC)
• Enrolled in hospice
• Dialysis (hemodialysis or peritoneal dialysis)
• Residing in nursing home, skilled nursing facility, or CLC.
• Living <20 miles or 60 miles from the Indianapolis VAMC facility

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: TeleGRACE; Patients receive a virtual home visit and care from the GRACE team	Other: TeleGRACE; Patients receive a virtual home visit and care from the GRACE team
No Intervention: Usual Care; Patients receive usual care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
90-day All-cause Mortality	The primary outcome is 90-day all-cause mortality measured from the date of discharge from the index hospitalization.	90-days from discharge from the index hospitalization

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Dawn M. Bravata, MD, Richard L. Roudebush VA Medical Center, Indianapolis, IN

Study record dates

Study Major Dates

• Study Start (Actual): October 18, 2021
• Primary Completion (Actual): April 29, 2022
• Study Completion (Actual): April 29, 2022

Study Registration Dates

• First Submitted: December 8, 2021
• First Submitted That Met QC Criteria: December 8, 2021
• First Posted (Actual): December 22, 2021

Study Record Updates

• Last Update Posted (Actual): January 22, 2024
• Last Update Submitted That Met QC Criteria: December 21, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: telehealth; home visit; comprehensive geriatrics assessment
• Other Study ID Numbers: QUX 21-007; QUE HX0003205-01 (Other Grant/Funding Number: VA HSRD QUERI)

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
• product manufactured in and exported from the U.S.: No