Post-Acute Physician Home Visit Program
9. august 2019 opdateret af: Jeffrey L. Schnipper, MD.,MPH., Brigham and Women's Hospital
Post-Acute Physician Home Visits: A Randomized Controlled Trial
New or worsening symptoms following discharge from the hospital likely leads to unplanned readmission.
These rates are higher than desired and costly to patients, payers, and providers.
Many interventions have unsuccessfully attempted to reduce readmissions, but few have provided in-home personnel to patients transitioning from acute care back to ambulatory care.
Still fewer have involved a physician in the home.
We therefore will test the effect of a physician home visit to a patient's home who was discharged in the last 4 days.
Studieoversigt
Status
Afsluttet
Intervention / Behandling
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
51
Fase
- Ikke anvendelig
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
-
-
Massachusetts
-
Boston, Massachusetts, Forenede Stater, 02115
- Brigham and Women's Hospital
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Boston, Massachusetts, Forenede Stater, 02130
- Brigham and Women's Faulkner Hospital
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-
Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år og ældre (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
Inclusion Criteria:
- Resides within either a 5-mile or 20-minute driving radius of Brigham and Women's Hospital (BWH) or Brigham and Women's Faulkner Hospital (BWFH) emergency room
- Has capacity to consent to study
- >=18 years old
Exclusion Criteria:
- Undomiciled
- In police custody
- Domestic violence screen positive
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Støttende pleje
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: Home visit
A participant in this arm will receive a home visit after discharge from the hospital.
|
The visit will be entirely patient tailored, last approximately one hour, and at a minimum will entail:
|
|
Ingen indgriben: Usual Care
A participant in this arm will not receive a home visit after discharge from the hospital.
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
New or worsening symptoms
Tidsramme: 30 days after discharge from hospital
|
"Since you got home from the hospital, have you had any symptoms at all?" If no, stop. If yes, continue. "I'm going to read off a list of symptoms, and I want you to tell me if that symptom is new or has gotten worse since you left the hospital. Please don't include symptoms that have stayed the same since you were in the hospital." For each affirmative, double check if the symptom is new or has gotten worse since getting out of the hospital. Only if new or worse, mark yes. |
30 days after discharge from hospital
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
3-element Care Transition Mål, score
Tidsramme: 30 dage efter udskrivelsen
|
30 dage efter udskrivelsen
|
|
|
Total cost, 30-days post discharge
Tidsramme: Day of discharge to 30 days later
|
Day of discharge to 30 days later
|
|
|
Total reimbursement, 30-days post discharge
Tidsramme: Day of discharge to 30 days later
|
Day of discharge to 30 days later
|
|
|
Primary care provider follow-up within 14 days, y/n
Tidsramme: Day of discharge to 14 days later
|
Day of discharge to 14 days later
|
|
|
Ability to carry out the discharge plan, score
Tidsramme: 30 days after discharge
|
I would like to ask you about some more problems that you might have faced after you left the hospital one month ago.
I will read some statements and ask if you agree or disagree.
|
30 days after discharge
|
|
Change in medication list due to home visit, y/n
Tidsramme: Day of home visit
|
Physician-initiated medication change during home visit
|
Day of home visit
|
|
Receipt of prescribed medicines following discharge, y/n
Tidsramme: 30 days after discharge
|
Pharmacy confirmation
|
30 days after discharge
|
|
Unplanned 30-day readmission(s) after index hospitalization, y/n
Tidsramme: 30 days after discharge
|
30 days after discharge
|
|
|
Unplanned 30-day readmission(s) after index hospitalization, #
Tidsramme: 30 days after discharge
|
30 days after discharge
|
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Global satisfaction with care, score
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Days at home since discharge, #
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
All-cause 30-day readmission(s) after index hospitalization, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
All-cause 30-day readmission(s) after index hospitalization, #
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Emergency Department (ED) observation stay(s) after index hospitalization, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Emergency Department (ED) observation stay(s) after index hospitalization, #
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Emergency Department (ED) visit(s) after index hospitalization, #
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Emergency Department (ED) visit(s) after index hospitalization, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Imaging, #
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Imaging, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Lab orders, #
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Lab orders, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Physician visits, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Physician visits, #
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Home health utilization, days
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Home health utilization, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
All cause 30-day mortality, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Unplanned 30-day mortality, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Change in medication list due to error at discharge, y/n
Tidsramme: Visit date
|
Exploratory
|
Visit date
|
|
Pneumococcal vaccination if appropriate, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Influenza vaccination if appropriate, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Smoking cessation counseling if appropriate, y/n
Tidsramme: 30 days after discharge
|
Exploratory
|
30 days after discharge
|
|
Evaluation of ejection fraction as assessed by echocardiogram or other appropriate study, scheduled or completed, if not done within 1 year; y/n
Tidsramme: 30 days after discharge
|
Heart failure patients only; Exploratory; appropriate studies include cardiac magnetic resonance imaging, radionuclide ventriculography, single photon emission computed tomography myocardial perfusion imaging, or left ventriculography
|
30 days after discharge
|
|
Angiotensin converting enzyme inhibitor or angiotensin receptor blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n
Tidsramme: 30 days after discharge
|
Heart failure patients only; Exploratory
|
30 days after discharge
|
|
Beta blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n
Tidsramme: 30 days after discharge
|
Heart failure patients only; Exploratory
|
30 days after discharge
|
|
Aldosterone antagonist for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n
Tidsramme: 30 days after discharge
|
Heart failure patients only; Exploratory
|
30 days after discharge
|
|
Lipid lowering for coronary artery disease, peripheral vascular disease, cerebrovascular accident, or diabetes, y/n
Tidsramme: 30 days after discharge
|
Heart failure patients only; Exploratory
|
30 days after discharge
|
|
Smoking status post-discharge
Tidsramme: 30 days after discharge
|
Heart failure patients only; Exploratory
|
30 days after discharge
|
|
Use of inappropriate medications in the elderly, y/n
Tidsramme: 30 days after discharge
|
Exploratory; using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Beers criteria
|
30 days after discharge
|
|
Time between discharge and visit, days
Tidsramme: Date of home visit
|
Exploratory
|
Date of home visit
|
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Duration of physician visit, minutes
Tidsramme: Date of home visit
|
Exploratory
|
Date of home visit
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Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Sponsor
Efterforskere
- Ledende efterforsker: Jeffrey Schnipper, MD MPH, Brigham and Women's Hospital
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Generelle publikationer
- Epstein K, Juarez E, Loya K, Gorman MJ, Singer A. Frequency of new or worsening symptoms in the posthospitalization period. J Hosp Med. 2007 Mar;2(2):58-68. doi: 10.1002/jhm.170.
- Boling PA. Care transitions and home health care. Clin Geriatr Med. 2009 Feb;25(1):135-48, viii. doi: 10.1016/j.cger.2008.11.005.
- Meyer GS, Gibbons RV. House calls to the elderly--a vanishing practice among physicians. N Engl J Med. 1997 Dec 18;337(25):1815-20. doi: 10.1056/NEJM199712183372507.
- Wong FK, Chow SK, Chan TM, Tam SK. Comparison of effects between home visits with telephone calls and telephone calls only for transitional discharge support: a randomised controlled trial. Age Ageing. 2014 Jan;43(1):91-7. doi: 10.1093/ageing/aft123. Epub 2013 Aug 26.
- Branowicki PM, Vessey JA, Graham DA, McCabe MA, Clapp AL, Blaine K, O'Neill MR, Gouthro JA, Snydeman CK, Kline NE, Chiang VW, Cannon C, Berry JG. Meta-Analysis of Clinical Trials That Evaluate the Effectiveness of Hospital-Initiated Postdischarge Interventions on Hospital Readmission. J Healthc Qual. 2017 Nov/Dec;39(6):354-366. doi: 10.1097/JHQ.0000000000000057.
- Wolff JL, Meadow A, Boyd CM, Weiss CO, Leff B. Physician evaluation and management of Medicare home health patients. Med Care. 2009 Nov;47(11):1147-55. doi: 10.1097/MLR.0b013e3181b58e30.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart (Faktiske)
6. juni 2017
Primær færdiggørelse (Faktiske)
20. januar 2018
Studieafslutning (Faktiske)
20. januar 2018
Datoer for studieregistrering
Først indsendt
5. juni 2017
Først indsendt, der opfyldte QC-kriterier
5. juni 2017
Først opslået (Faktiske)
7. juni 2017
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
13. august 2019
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
9. august 2019
Sidst verificeret
1. august 2019
Mere information
Begreber relateret til denne undersøgelse
Andre undersøgelses-id-numre
- P000719
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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