A Prospective Randomised Control Trial to Study the Effectiveness of a Health Service Innovation Using a Modified Virtual Ward Model to Prevent Unscheduled Readmission of High Risk Patients

NCT02325752 | Completed

• 1 other identifier: 2011/380/E
• Study Type: interventional
• Target: 840
• Locations: 0 countries
• Sites: N/A

Brief Summary

The investigators conducted an open randomized control study of patients who received the transitional care program versus patients who received usual care at the Singapore General Hospital from Aug 2011 to Sept 2012.

Conditions

Chronic Diseases

Keywords

readmission; chronic diseases

Outcome Measures

Primary Outcomes (1)

• Rate of readmission

  Any hospital admission after randomisation

  30 days

Study Arms (2)

Control

NO INTERVENTION

Patients in the control group received usual care by the hospital. There was no contact between the patients in the control group and the study team throughout the 3 months interval. A scheduled telephone call was made at the end of 3 months when they were invited to participate in a telephone survey.

Intervention

ACTIVE COMPARATOR

Intervention

Other: Intervention

Interventions

Intervention OTHER

A multidisciplinary team delivered the transitional care program. Our transitional care program focused on four key areas: 1. Post discharge surveillance of the patient to ensure adherence to care plans. 2. Coordination of follow-up visits with specialist care providers. 3. Patent education and care giver training. 4. Activation of community and social services. Upon recruitment, the patients were interviewed and assessed by the team nurse prior to their discharge. Intervention starts upon discharge from the hospital. The duration of the intervention program was 3 months. A follow-up by telephone was made within 72 hours after discharge to assess patient's condition and adherence to treatment plan. Home visits were made within 2 weeks after discharge.

Intervention

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients with 2 or more unscheduled admission in the last 90 days to selected medical departments
• LACE score of ≥10.

You may not qualify if:

• Non-residents
• No telephone contact or a resident address
• Residing in long term care facilities.

Sponsors & Collaborators

• Singapore General Hospital: lead
• Agency for Integrated Care, Singapore: collaborator
• Duke-NUS Graduate Medical School: collaborator

Related Publications (1)

• Lee KH, Low LL, Allen J, Barbier S, Ng LB, Ng MJ, Tay WY, Tan SY. Transitional care for the highest risk patients: findings of a randomised control study. Int J Integr Care. 2015 Oct 22;15:e039. doi: 10.5334/ijic.2003. eCollection 2015 Oct-Dec.

  PMID: 27118956 DERIVED

MeSH Terms

Conditions

Chronic Disease

Interventions

Methods

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Investigative Techniques

Study Officials

• Kheng Hock Lee, MBBS

  Singhealth Foundation

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 21, 2014
• First Posted: December 25, 2014
• Study Start: August 1, 2011
• Primary Completion: October 1, 2012
• Study Completion: January 1, 2013
• Last Updated: February 10, 2017

Record last verified: 2017-02