Post Discharge After Surgery Virtual Care with Remote Automated Monitoring Technology-3 Trial (PVC-RAM-3)

Post Discharge After Surgery Virtual Care with Remote Automated Monitoring Technology-3 (PVC-RAM-3) Trial

The Post discharge after surgery Virtual Care with Remote Automated Monitoring technology (PVC-RAM)-3 Trial is a multicentre, parallel group, superiority, randomized controlled trial to determine the effect of virtual care with remote automated monitoring (RAM) technology compared to standard care on length of index hospital stay and use of acute hospital care (composite of hospital readmission and emergency department visit) after randomization, in adults who have undergone elective non cardiac surgery. Secondary outcomes at 30 days after randomization include: 1) hospital re-admission; 2) emergency department visit; 3) medication error detection;4) medication error correction; 5) surgical site infection; and 6) days in hospital. Additional secondary outcomes are pain of any severity, and moderate-to-severe pain assessed at 15 and 30 days after randomization. The investigators will also assess optimal management of long-term health by evaluating among patients with atherosclerotic disease and current smokers whether patients are taking classes of efficacious medications at 30 days.

Study Overview

• Status: Active, not recruiting
• Conditions: Surgery
• Intervention / Treatment: Device: Virtual care with remote automated monitoring (RAM)

• Study Type: Interventional
• Enrollment (Actual): 2500
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada
      • Hamilton General Hospital
    • Hamilton, Ontario, Canada
      • Juravinski Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. are ≥18 years of age;
2. are undergoing inpatient elective noncardiac surgery with an expected length of hospital stay ≤3 days after surgery; and
3. provide informed consent to participate.

Exclusion Criteria:

1. are unable to communicate with research staff, complete study surveys, or undertake an interview using a tablet computer due to a language barrier or a cognitive, visual, or hearing impairment; or
2. reside in an area without cellular network coverage.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual Care with Remote Automated Monitoring; Patients randomized to the PVC-RAM-3 intervention will take biophysical measurements with the RAM technology, complete a daily recovery survey, complete video visits with a virtual care clinical team, and take wound photos during the 14 days after discharge. If the patient's RAM measurements exceed predetermined thresholds, the patient reports specific symptoms (e.g., shortness of breath), a drug error is identified, or the virtual nurse has concerns about the patient's health that they cannot resolve, the virtual nurse will escalate care to a pre-assigned and available physician.	Device: Virtual care with remote automated monitoring (RAM); Use of Cloud Diagnostics connected health kit for at home monitoring with virtual clinical from nursing and perioperative physician team.
No Intervention: Standard Care; Standard post surgical care per treating institution.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Index hospital length of stay	Length of stay from randomization until discharge from the index hospitalization (measured in days and hours)	30 Days post randomization
Acute hospital care (composite of hospital readmission and emergency department visit)	Acute-hospital care is a composite outcome of hospital re-admission and emergency department visit, which includes urgent-care centre visit.	30 Days post randomization

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospital readmission	Patient admission to an acute-care hospital.	30 days post randomization
Emergency department visit (includes urgent care centre visit)	Patient visit to an emergency department, which includes urgent-care centre visit.	30 days post randomization
Medication error detection	Medication errors include mistakes in medication prescribing, transcribing, dispensing, administering, or monitoring due to preventable events or actions taken by a patient, caregiver, or healthcare worker. Medication errors include: drug omission (i.e., patient did not take a drug they were supposed to take), drug commission (i.e., patient taking a drug they were not supposed to take), duration error, dosing error, frequency error, route error, and timing error. We will record all drug errors identified.	30 days post randomization
Medication error correction	Any medication error that is corrected.	30 days post randomization
Surgical site infection	Surgical site infection is an infection that occurs within 30 days after randomization and involves the skin, subcutaneous tissue of the incision (superficial incisional), or the deep soft tissue (e.g., fascia, muscle) of the incision (deep incisional).	30 days post randomization
Days in hospital	Days in hospital	30 days post randomization
Level of pain and pain related interference in recovery	Pain intensity and related interference with usual daily activities, will be measured via the Brief Pain Inventory-Short Form (BPI-SF).4 The BPI-SF includes four 11-point numeric rating scales (NRS) of pain intensity, which measure "average", "least", and "worst" pain intensity in the past 24 hours (hrs.), respectively, as well as pain intensity "now" (0= no pain, 10= pain as bad as you can imagine). The BPI-SF interference subscale will also be used, which measures the degree to which pain interferes with general activity, mood, walking, work, relations with others, sleep, and enjoyment of life (NRS for each item; 0=does not interfere, 10=completely interferes). A total interference score is determined by calculating the sum of these 7 items. The BPI-SF has strong psychometric properties with well-established reliability and validity across divergent surgical groups. Moderate to severe pain is defined by a score of ≥4/10 on a standard numeric rating scale (NRS) for pain.	15 and 30 days post randomization
Optimization of medications for long-term health	Among patients with atherosclerotic disease, we will also assess optimal pharmacological management based upon whether patients are taking 0, 1, 2, or 3 of the following classes of efficacious medications at 30 days (i.e., an antiplatelet or anticoagulant drug; an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker; and a statin). Among active smokers before surgery we will assess if patients are receiving pharmacological smoking cessation interventions at 30 days after randomization.	30 days post randomization

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Infection	Infection is defined as a pathologic process caused by the invasion of normally sterile tissue, fluid, or body cavity by pathogenic or potentially pathogenic organisms.	30 days post randomization
Re-operation	Re-operation refers to any surgical procedure undertaken for any reason (e.g., wound dehiscence, infection).	30 days post randomization
Death	All cause mortality	30 days post randomization
Health related quality of life (HRQoL)	HRQoL will be measured with the EQ-5D-5L instrument (https://euroqol.org/eq-5d-instruments/sample-demo) due to its increased sensitivity and validation in several countries including Canada.4 The EQ-5D-5L is also recommended in Canada5 to calculate the Quality Adjusted Life Years (QALYs) when conducting cost-effectiveness analyses.	30 days post randomization
Health services utilization-related costs	Data on hospital re-admission, length of stay, and healthcare utilization will be obtained from the Ontario Hospital Association Integrated Decision Support (IDS) database. IDS is a comprehensive platform with an integrated view of patient activity, allowing for access to health systems data for any patients enrolled. Data on costs of health service utilization will be obtained from the Ontario Case Costing Database.	30 days post randomization
Composite of myocardial infarction, acute heart failure, and arrhythmia that results in acute hospital care	The diagnosis of myocardial infarction requires criteria meeting 4th universal definition of myocardial infarction. The definition of acute heart failure requires at least one of the following clinical signs (i.e., elevated jugular venous pressure, respiratory rales or crackles, crepitations, or presence of S3) with at least one of the following: radiographic findings of vascular redistribution, interstitial pulmonary edema, or frank alveolar pulmonary edema, OR; heart failure treatment with a diuretic and documented clinical improvement. Any arrhythmia that results in patient presenting to an emergency department, which includes an urgent care centre visit or being admitted to hospital.	30 days post randomization

Collaborators and Investigators

• Sponsor: Population Health Research Institute
• Collaborators: Hamilton Health Sciences Corporation
• Investigators: Principal Investigator: Michael McGillion, PhD, McMaster University, Population Health Research Institute; Principal Investigator: PJ Devereaux, M.D, PhD, McMaster University, Population Health Research Institute

Study record dates

Study Major Dates

• Study Start (Actual): December 28, 2021
• Primary Completion (Actual): November 30, 2024
• Study Completion (Estimated): May 31, 2025

Study Registration Dates

• First Submitted: December 10, 2021
• First Submitted That Met QC Criteria: December 10, 2021
• First Posted (Actual): December 29, 2021

Study Record Updates

• Last Update Posted (Actual): March 27, 2025
• Last Update Submitted That Met QC Criteria: March 24, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Virtual care
• Other Study ID Numbers: v2.0_2025-01-25

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