Support From Hospital to Home for Elders: A Randomized Controlled Study

NCT01221532 | Completed

• 1 other identifier: SHHE2010
• Study Type: interventional
• Target: 699
• Locations: 1 country
• Sites: 1

Brief Summary

The investigators will randomize 700 non-psychiatric, non-obstetric, non-surgical patients aged 55 years and older at San Francisco General Hospital (SFGH) to usual care (ten days of prescription medication, discharge summary sent to primary care provider (PCP), and outpatient appt made for patient, and patient's nurse reviews discharge plan,) or usual care plus a peridischarge intervention (a visit with specialized in-hospital discharge nurse, development of personalized discharge plan, two phone calls from a nurse practitioner(NP)/physician assistant (PA) after discharge and availability of additional calls back from NP/PA, upon patient request, to help answer questions and assist patient's transition to outpatient care, and communication with primary care/subspecialty providers). The usual care and usual care plus intervention groups will be assessed for differences in mortality and rates of rehospitalization and emergency department use 30, 90 and 180 days following discharge from the hospital. The discharge process from the hospital to home is frequently marked by poor quality and high risk of adverse events and readmissions. It has been hypothesized that better coordinated care, personalized patient education, and follow-up calls to identify potential sources of adverse events, such as medical complications and medication errors can reduce rehospitalization and emergency room visits following discharge from the hospital. Although these interventions have been shown to reduce combined hospital readmissions and emergency department visits in English-speaking patients, none has focused on elderly patients in a diverse urban public hospital setting that includes non-English-speakers, who might benefit more than other populations from enhanced services during and after discharge from the hospital. Further, these labor-intensive interventions are costly to implement, and it is unknown whether opportunity cost of providing additional services in a limited-resource environment such as San Francisco General Hospital (SFGH) outweighs the unknown clinical benefits.

Conditions

Hospital Readmissions

Outcome Measures

Primary Outcomes (3)

• Combined Emergency Department Visits and Inpatient Readmissions

  30 days after discharge from hospital

• Combined Emergency Department Visits and Inpatient Readmissions

  90 days after discharge from hospital

• Combined Emergency Department Visits and Inpatient Readmissions

  180 days after discharge from hospital

Study Arms (2)

SHHE Peridischarge intervention

EXPERIMENTAL

Patients receive the Support from Hospital to Home (SHHE) Peridischarge Intervention plus usual care

Behavioral: SHHE Peridischarge Intervention

Usual Care

NO INTERVENTION

Interventions

SHHE Peridischarge Intervention BEHAVIORAL

Support from Hospital to Home (SHHE) Peridischarge Intervention patients will receive Usual care plus 1. a visit with in-hospital registered nurse, who provides additional patient education, assesses patient's needs post-hospitalization, communicates with the medical team, and develops a personalized discharge plan; 2. two phone calls from a nurse practitioner(NP)/physician assistant (PA) after discharge, in which adherence to medications, treatment plan, and access to outpatient care, and other issues identified during the hospitalization will be explored; 3. the provision of a phone support line, on which an NP/PA will call patients back within 24 hours to answer questions and assist transition to outpatient care.

SHHE Peridischarge intervention

Eligibility Criteria

• Age: 55 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• patients age 55 and older
• admitted to the general medicine, family medicine, cardiology, and neurology services at San Francisco General Hospital,
• able to communicate in either English, Spanish, Mandarin or Cantonese,
• attending physicians agree to the patient's participation.
• Patients must be able to demonstrate an understanding of the study's goals through a set of teach back questions included in the consent process.

You may not qualify if:

• transferred from an outside hospital;
• admitted for a planned hospitalization (e.g. chemotherapy, a planned surgery)
• requiring hospice, nursing home, rehab or other institutional settings (i.e. expected by the physician team to be discharged to skilled nursing facilities) - those unable to independently consent (i.e. severely cognitively impaired, delirious, deaf, or involuntarily hospitalized because of severe mental illness)
• unable to understand English, Spanish or Cantonese (as reported by medical teams or unable to complete the consent teach-back process)
• less than age 55
• aphasic
• otherwise excluded by the medical team
• participated in the pilot project of this intervention.

Sponsors & Collaborators

• University of California, San Francisco: lead
• Gordon and Betty Moore Foundation: collaborator

Study Sites (1)

San Francisco General Hospital

San Francisco, California, 94110, United States

Location

Related Publications (3)

• Chan B, Goldman LE, Sarkar U, Guzman D, Critchfield J, Saha S, Kushel M. High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population. BMC Health Serv Res. 2019 May 24;19(1):334. doi: 10.1186/s12913-019-4162-6.

  PMID: 31126336 DERIVED

• Chan B, Goldman LE, Sarkar U, Schneidermann M, Kessell E, Guzman D, Critchfield J, Kushel M. The Effect of a Care Transition Intervention on the Patient Experience of Older Multi-Lingual Adults in the Safety Net: Results of a Randomized Controlled Trial. J Gen Intern Med. 2015 Dec;30(12):1788-94. doi: 10.1007/s11606-015-3362-y.

  PMID: 25986136 DERIVED

• Goldman LE, Sarkar U, Kessell E, Guzman D, Schneidermann M, Pierluissi E, Walter B, Vittinghoff E, Critchfield J, Kushel M. Support from hospital to home for elders: a randomized trial. Ann Intern Med. 2014 Oct 7;161(7):472-81. doi: 10.7326/M14-0094.

  PMID: 25285540 DERIVED

Study Officials

• Jeffrey M Critchfield, MD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

• Sue Currin, RN

  San Francisco General Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 13, 2010
• First Posted: October 15, 2010
• Study Start: July 1, 2010
• Primary Completion: February 1, 2012
• Study Completion: July 1, 2013
• Last Updated: July 9, 2013

Record last verified: 2013-07

Locations

US (1)