Effects Of Income Supplements On 30-Day Readmissions For Vulnerable Older Adults

Effects Of Income Supplements On 30-Day Readmissions For Vulnerable Older Adults: A Randomized, Controlled, 300-Subject Clinical Trial

Unplanned 30-day hospital readmissions are an critical healthcare quality metric, with meaningful effects on patients and health systems operations. Interventions to reduce unplanned readmissions have primarily operated within a healthcare-centric frame, with enhancements to either pre- or post-discharge care planning, medication reconciliation, or visit frequency. Associations of 30-day readmission rates with poverty status and other social factors, however, suggest that attending to unmet social needs may yield added benefits to models focused on healthcare delivery. The purpose of the present trial is to provide evidence regarding the effects on 30-day readmissions of providing a one-time post-discharge income supplement to socially vulnerable older adults with medical complexity participating in an enhanced care coordination program.

Study Overview

• Status: Terminated
• Conditions: Patient Readmission
• Intervention / Treatment: Other: Enhanced care planning; Other: Post-discharge income supplement

• Study Type: Interventional
• Enrollment (Actual): 8
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90040
      • AltaMed Health Services Corporation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• A participant in the underlying enhanced care planning program
• aged 55 years or older
• attending an outpatient clinic appointment as part of the underlying enhanced care planning program within 10 days of being discharged from an inpatient hospital stay
• able to understand the study consent form (with interpretation services if needed)

Exclusion Criteria:

• The candidate is not discharged from the index admission to a community setting (e.g., they will be excluded if they are discharged to a skilled nursing facility)
• The candidate has a legal guardian with control over financial decision-making
• The candidate has been approached about the study during a previous encounter
• The index hospitalization was a planned admission

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control; Enhanced care planning only (plus $15 as compensation for participation)	Other: Enhanced care planning; Enhanced care planning provided by a nurse care manager
Experimental: Intervention; Enhanced care planning plus a one-time $300 post-discharge income supplement	Other: Enhanced care planning; Enhanced care planning provided by a nurse care manager; Other: Post-discharge income supplement; $300 income supplement

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Unplanned 30-day readmission	Whether a participant has an unplanned readmission within 30 days of the index hospital discharge	Within 30 days of the index hospital discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
30-day post-discharge medical expenditures	Total medical expenditures in the 30 days after the index hospital discharge	Within 30 days of the index hospital discharge
90-day post-discharge medical expenditures	Total medical expenditures in the 90 days after the index hospital discharge	Within 90 days of the index hospital discharge
30-day post-discharge medical readmission OR emergency department visit	Whether a participant has an unplanned readmission OR emergency department visit within 30 days of the index hospital discharge	Within 30 days of the index hospital discharge
90-day post-discharge medical readmission OR emergency department visit	Whether a participant has an unplanned readmission OR emergency department visit within 90 days of the index hospital discharge	Within 90 days of the index hospital discharge
Unplanned 90-day readmission	Whether a participant has an unplanned readmission within 90 days of the index hospital discharge	Within 90 days of the index hospital discharge

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-discharge care plan adherence	Clinic visit attendance, medication fills/refills	Within 90 days of the index hospital discharge

Collaborators and Investigators

• Sponsor: AltaMed Health Services Corporation
• Collaborators: National Institute on Aging (NIA); University of Southern California
• Investigators: Principal Investigator: Rajan A Sonik, PhD, JD, MPH, Brandeis University

Publications and helpful links

General Publications

• Calvillo-King L, Arnold D, Eubank KJ, Lo M, Yunyongying P, Stieglitz H, Halm EA. Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. J Gen Intern Med. 2013 Feb;28(2):269-82. doi: 10.1007/s11606-012-2235-x. Epub 2012 Oct 6.

Study record dates

Study Major Dates

• Study Start (Actual): June 21, 2023
• Primary Completion (Actual): April 22, 2024
• Study Completion (Actual): April 22, 2024

Study Registration Dates

• First Submitted: March 23, 2023
• First Submitted That Met QC Criteria: March 29, 2023
• First Posted (Actual): April 11, 2023

Study Record Updates

• Last Update Posted (Actual): June 3, 2024
• Last Update Submitted That Met QC Criteria: May 31, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: Income; Patient Readmission
• Other Study ID Numbers: 2023-001 Sonik Readmit RCT; P30AG024968 (U.S. NIH Grant/Contract)

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