Discharge Information and Support for Patients Receiving Outpatient Care in the Emergency Department

NCT01717976 | Completed Results

• 1 other identifier: IIR 12-052
• Study Type: interventional
• Target: 513
• Locations: 1 country
• Sites: 1

Brief Summary

The Veterans' Health Administration (VHA) is committed to improving primary care through the implementation of Patient Aligned Care Teams (PACTs). Improving access to services and care coordination are among the primary goals of PACTs; however, there remain many unanswered questions about how best to use the limited time of PACT team members, such as nurse care managers, to accomplish this. This study will evaluate the effectiveness of a nurse-led telephone support program for Veterans who have been treated recently in the emergency department (ED) and are at high risk for repeat visits. The program's goals are to reduce the need for future ED use and improve satisfaction among Veterans by providing information and support related to the ED visit, enhancing chronic disease management and educating Veterans and family members about PACT and other VA and community services. If proven effective, this program could improve health and healthcare for a large, vulnerable group of Veterans and be cost saving for VHA.

Conditions

Multimorbidity

Keywords

emergency department use; Veterans

Outcome Measures

Primary Outcomes (1)

• Number of Participants Experiencing Repeat ED Use

  Number of Participants Experiencing Repeat ED Use

  30 days

Secondary Outcomes (4)

• Number of Participants Satisfied With Health Care

  Baseline

• Number of Participants Satisfied With Health Care

  30 days

• Number of Participants Satisfied With Health Care

  180 days

• Total Costs to the VHA

  180 days

Study Arms (2)

Intervention

EXPERIMENTAL

primary care based nurse telephone support

Behavioral: DISPO ED

Control

NO INTERVENTION

usual care

Interventions

DISPO ED BEHAVIORAL

primary care based nurse telephone support

Intervention

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• To be included in the study, patients must meet all of the following:
• Treated and released from the Durham VA ED;
• Receive primary care from a Durham VAMC affiliated primary care clinic (at least one visit in a primary care clinic affiliated with the Durham VAMC within the previous 12 months);
• At least one VAMC ED visit or hospital admission within the 6 months preceding the index visit;
• Diagnosed with 2 or more chronic health conditions; and
• Valid telephone number in the medical record; in the investigators' pilot studies, 98.7% of Veterans had a valid phone number in the medical record.

You may not qualify if:

• Patients will be excluded if they meet any of the following:
• Reside in a nursing home (or other institutional setting);
• Unable to communicate on the telephone, and no proxy available;
• Lacks decision-making capacity, and no proxy available; or
• Returned to ED within 24 hours of discharge from initial visit.
• Have a current Category 1 high-risk suicide flag on their CPRS medical record; or Visit the PEC (Psychiatric Emergency Clinic) within 24 hours of discharge from initial ED visit.
• Enrolled in a study that prohibits cross-enrollment in other studies.

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

Durham VA Medical Center, Durham, NC

Durham, North Carolina, 27705, United States

Location

Related Publications (4)

• Hastings SN, Betts E, Schmader KE, Weinberger M, Van Houtven CH, Hendrix CC, Coffman CJ, Stechuchak KM, Weiner M, Morris K, Kessler C, Oddone EZ. Discharge information and support for veterans Receiving Outpatient Care in the Emergency Department: study design and methods. Contemp Clin Trials. 2014 Nov;39(2):342-50. doi: 10.1016/j.cct.2014.10.008. Epub 2014 Nov 3.

  PMID: 25445314 BACKGROUND

• Seidenfeld J, Ramos K, Bruening RA, Sperber NR, Stechuchak KM, Hastings SN. Patient experiences of a care transition intervention for Veterans to reduce emergency department visits. Acad Emerg Med. 2023 Apr;30(4):388-397. doi: 10.1111/acem.14661. Epub 2023 Jan 30.

  PMID: 36630213 DERIVED

• Ramos K, Shepherd-Banigan ME, Stechuchak KM, Coffman C, Oddone EZ, Van Houtven C, Hendrix CC, Mahanna EP, Hastings SN. Psychological distress among medically complex veterans with a recent emergency department visit. Psychol Serv. 2022 May;19(2):353-359. doi: 10.1037/ser0000437. Epub 2021 Apr 1.

  PMID: 33793285 DERIVED

• Hastings SN, Stechuchak KM, Coffman CJ, Mahanna EP, Weinberger M, Van Houtven CH, Schmader KE, Hendrix CC, Kessler C, Hughes JM, Ramos K, Wieland GD, Weiner M, Robinson K, Oddone E. Discharge Information and Support for Patients Discharged from the Emergency Department: Results from a Randomized Controlled Trial. J Gen Intern Med. 2020 Jan;35(1):79-86. doi: 10.1007/s11606-019-05319-6. Epub 2019 Sep 5.

  PMID: 31489559 DERIVED

Results Point of Contact

• Title: Susan N. Hastings
• Organization: Durham VA HSR&D

susan.hastings@va.gov

919-286-0411

Study Officials

• Susan N. Hastings, MD

  Durham VA Medical Center, Durham, NC

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 26, 2012
• First Posted: October 31, 2012
• Study Start: December 1, 2013
• Primary Completion: March 1, 2016
• Study Completion: November 1, 2016
• Last Updated: July 25, 2017
• Results First Posted: June 16, 2017

Record last verified: 2017-06

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)