- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05897125
Telehealth Education Leveraging Electronic Transitions Of Care for COPD Patients (TELE-TOC)
November 29, 2023 updated by: University of Chicago
TELE-TOC: Telehealth Education Leveraging Electronic Transitions Of Care for COPD Patients
Transitions of Care (TOC) between hospital, ambulatory, and home settings for high-risk, frequently hospitalized adults with chronic diseases, such as chronic obstructive pulmonary disease (COPD) are complex, costly, and vulnerable to safety threats and poor health outcomes.
One potential solution to address this gap in care is the Transitional Care Model (TCM), which utilizes a patient-centered approach with in-home interventions; since in-person in-home visits are costly, using innovative telehealth, such as virtual visits via teleconferencing may be just as effective with greater feasibility, scalability, and sustainability, particularly in the post-COVID-19 era as has been seen the rapid expansion of these technologies.
With a transdisciplinary team of experts from cognitive science, care transitions/handoffs, human factors engineering, design, implementation science, and health services research, the study team proposes to implement and evaluate via a randomized clinical trial the "TELE-TOC: Telehealth Education: Leveraging Electronic Transitions Of Care for COPD patients," intervention which includes a virtual visit, pharmacy-based, in-home intervention for COPD patients to improve medication use and patient outcomes among a population at high risk for readmission and medication safety events.
Study Overview
Status
Not yet recruiting
Conditions
Intervention / Treatment
- Other: Virtual at Home Medication Reconciliation Visit(s)
- Behavioral: Virtual At Home Medication Education Visit(s)
- Other: COPD advanced practice nurse Inpatient Consult
- Other: Inpatient Medication Reconciliation
- Other: Post-discharge nurse 48 hour phone follow-up call
- Other: Post-discharge follow-up advanced practice nurse outpatient visit
Detailed Description
Transitions of Care (TOC) for high-risk, frequently hospitalized adults with chronic diseases are complex, costly, and vulnerable to safety threats and poor health outcomes.
Communication breakdowns, information lapses, and IT-induced unintended consequences can result in poor follow-up and medication non-adherence, both of which contribute to preventable readmissions or emergency room (ER) visits.
The Transitional Care Model (TCM) aims to reduce such risks through a holistic, collaborative, patient-centered approach with in-home interventions.
Prior to the coronavirus disease 2019 (COVID-19) pandemic, most in- home interventions relied on in-person visits, which can be cost-prohibitive and unsustainable.
One potential sustainable and scalable solution is to use telehealth for in-home virtual visits; however, use of telehealth for post-discharge TOC interventions has not been routinely implemented.
In the post-COVID-19 era, given the rapid expansion of telehealth, hospitals are well-positioned to initiate this virtual care.
In-home virtual visits may be particularly promising for patients with chronic obstructive pulmonary disease (COPD), who are often hospitalized, have multiple comorbidities, and require intensive medication teaching due to rampant inhaler misuse.
COPD affects more than 16 million US adults, many of whom are older, contribute ~$50 billion to healthcare costs annually, experience high rates of acute care revisits, often due to care coordination failures.
For this reason, Medicare's Hospital Readmission Reduction Program (HRRP) aims to incentivize hospitals to implement TOC programs for increased quality and value of care for COPD patients.
However, currently, such programs fall short of aligning with the full TCM.
In-home interventions may be particularly salient for improving medication skills and outcomes for patients with COPD given rampant inhaler misuses, the effectiveness of in- hospital inhaler education, and evidence showing the need for inhaler education reinforcement post discharge.
Thus, our trans-disciplinary team proposes to implement and evaluate "TELE-TOC: Telehealth Education: Leveraging Electronic Transitions Of Care for COPD patients," which seeks to integrate virtual, pharmacy-based, in-home visits for COPD patients within our hospital's existing COPD HRRP.
The central hypotheses are that virtual visits with pharmacists will be feasible to implement and will result in improved medication use and outcomes among COPD patients at high risk for readmission.
The investigator aims to iteratively design TELE-TOC using participatory study design and stakeholder input.
The study team will then test the effectiveness of adding TELE-TOC virtual visits in a randomized controlled trial among COPD patients enrolled in the HRRP program.
Lastly, the study team will develop a plan for a dissemination strategy and roadmap with national stakeholders to facilitate wide scale adoption of TELE-TOC nation wide.
Study Type
Interventional
Enrollment (Estimated)
200
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
- Name: Leah Traeger
- Phone Number: 773-834-4489
- Email: ltraeger@bsd.uchicago.edu
Study Contact Backup
- Name: Valerie G Press, MD, MPH
- Phone Number: 7737025170
- Email: vpress@bsd.uchicago.edu
Study Locations
-
-
Illinois
-
Chicago, Illinois, United States, 60637
- University of Chicago
-
Principal Investigator:
- Vineet M Arora, MD, MAPP
-
Principal Investigator:
- Valerie G Press, MD, MPH
-
Contact:
- Leah Traeger
- Phone Number: 773-834-4489
- Email: ltraeger@bsd.uchicago.edu
-
Contact:
- Valerie G Press, MD, MPH
- Phone Number: 7737025170
- Email: vpress@bsd.uchicago.edu
-
Principal Investigator:
- Joanna Abraham, PhD
-
-
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
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Adults 40 years or older
- Admitted to the hospital on a general inpatient ward with a COPD Exacerbation
- Enrolled/seen by our COPD Hospital Readmission Reduction Program
Exclusion Criteria:
- Patients younger than 40 years of age
- Currently in the intensive care unit
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: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: TELE-TOC plus Usual Care
Patients randomized to this arm will receive the TELE-TOC intervention as well as the standard COPD care via the institution's COPD readmission reduction program.
|
Patients will have their medications reviewed by the TELE-TOC interventionalist, a member of the pharmacy team (anticipated)
Other Names:
Patients will be provided with inhaler education by the TELE-TOC interventionalist, a member of the pharmacy team (anticipated)
Other Names:
Patients will receive a COPD consult by an advanced practice nurse as part of standard of care
Other Names:
Patients will have their medications reviewed by member(s) of the clinical care team as part of standard of care
Patients will receive a post-discharge nurse 48 hour phone follow-up call as part of standard of care
Patients will be scheduled for a 1-2 week post-discharge visit with the COPD advanced practice nurse as part of standard of care
|
Active Comparator: Usual Care
Patients randomized to this arm will receive standard COPD care via the institution's COPD readmission reduction program.
|
Patients will receive a COPD consult by an advanced practice nurse as part of standard of care
Other Names:
Patients will have their medications reviewed by member(s) of the clinical care team as part of standard of care
Patients will receive a post-discharge nurse 48 hour phone follow-up call as part of standard of care
Patients will be scheduled for a 1-2 week post-discharge visit with the COPD advanced practice nurse as part of standard of care
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Correct inhaler technique 30 days post discharge
Time Frame: 30 days post discharge
|
Correct inhaler technique within 30 days post-discharge compared to baseline technique in hospital based on standardized checklists (<75% correct steps = misuse)
|
30 days post discharge
|
Reach of the TELE-TOC intervention
Time Frame: 1-2 weeks post discharge
|
Proportion of patients receiving at home inhaler education within 1-2 weeks post discharge
|
1-2 weeks post discharge
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
30 day revisits
Time Frame: 30 -days
|
proportion of patients with any emergency department visit and/or re-hospitalization within 30 days of index admission
|
30 -days
|
90 day revisits
Time Frame: 90 -days
|
proportion of patients with any emergency department visit and/or re-hospitalization within 90 days of index admission
|
90 -days
|
180 day revisits
Time Frame: 180 -days
|
proportion of patients with any emergency department visit and/or re-hospitalization within 180 days of index admission
|
180 -days
|
Medication errors
Time Frame: Within 30 days
|
Proportion of patients with medication errors at TELE-TOC visit medication reconciliation
|
Within 30 days
|
COPD Symptoms option 1
Time Frame: Within 30 days
|
Evaluation of COPD symptoms using COPD Assessment Test (CAT)
|
Within 30 days
|
COPD Symptoms option 2
Time Frame: Within 30 days
|
Evaluation of COPD symptoms using the modified medical Research Council Scale (mmRC) [Scale = 0 to 4; 0 (better) = Breathlessness only on strenuous exercise; 4 (worse)= too breathless to leave the house or breathless when dressing or undressing]
|
Within 30 days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Valerie G Press, MD, MPH, University of Chicago
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
- Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009 Apr 2;360(14):1418-28. doi: 10.1056/NEJMsa0803563. Erratum In: N Engl J Med. 2011 Apr 21;364(16):1582.
- Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The care span: The importance of transitional care in achieving health reform. Health Aff (Millwood). 2011 Apr;30(4):746-54. doi: 10.1377/hlthaff.2011.0041.
- Locke ER, Thomas RM, Woo DM, Nguyen EHK, Tamanaha BK, Press VG, Reiber GE, Kaboli PJ, Fan VS. Using Video Telehealth to Facilitate Inhaler Training in Rural Patients with Obstructive Lung Disease. Telemed J E Health. 2019 Mar;25(3):230-236. doi: 10.1089/tmj.2017.0330. Epub 2018 Jul 17.
- Thomas RM, Locke ER, Woo DM, Nguyen EHK, Press VG, Layouni TA, Trittschuh EH, Reiber GE, Fan VS. Inhaler Training Delivered by Internet-Based Home Videoconferencing Improves Technique and Quality of Life. Respir Care. 2017 Nov;62(11):1412-1422. doi: 10.4187/respcare.05445. Epub 2017 Jul 18.
- Press VG, Au DH, Bourbeau J, Dransfield MT, Gershon AS, Krishnan JA, Mularski RA, Sciurba FC, Sullivan J, Feemster LC. Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2019 Feb;16(2):161-170. doi: 10.1513/AnnalsATS.201811-755WS.
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 (Estimated)
March 1, 2024
Primary Completion (Estimated)
September 30, 2025
Study Completion (Estimated)
December 31, 2025
Study Registration Dates
First Submitted
May 10, 2023
First Submitted That Met QC Criteria
May 31, 2023
First Posted (Actual)
June 9, 2023
Study Record Updates
Last Update Posted (Actual)
November 30, 2023
Last Update Submitted That Met QC Criteria
November 29, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Other Study ID Numbers
- IRB21-1325
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
IPD Plan Description
Pending ethical approvals and data sharing allowances may be able to provide de-identified data to other researchers
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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.
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