Paramedic Coached ED Care Transitions to Help Older Adults Maintain Their Health

NCT02520661 | Completed Results

• 4 other identifiers: 2015-1197R01AG050504A534100SMPH\EMERG MED
• Study Type: interventional
• Target: 1,979
• Locations: 1 country
• Sites: 2

Brief Summary

The emergency department (ED) is a common source of acute illness care for older adults. Many older adults who are discharged home from the ED return within 30 days due to numerous challenges faced during the ED-to-home transition. Unless programs to improve the ED-to-home transition are identified, the health and financial costs will only increase as the older adult population doubles by 2040. This study will apply Coleman's Care Transitions Intervention to the ED-to-home transition by adapting the program to account for the unique aspects of the ED setting. The research will evaluate the process, ED use, and cost outcomes of a community-based, paramedic-coordinated Care Transitions Intervention. Upon completion, this study will provide empiric evidence regarding this innovative approach to help the rapidly growing older adult population remain healthy and independent after an ED visit.

Conditions

Emergencies; Aging

Outcome Measures

Primary Outcomes (3)

• Number of Participants Returning to the ED Within 30 Days of the Original ED Visit

  The investigators included all unplanned ED use, regardless of reason, during the 30 days after discharge as abstracted from electronic medical records (with out-of-system ED use identified during participant phone surveys). The investigators constructed dichotomous variables measuring whether or not any ED visits occurred within 14 and 30 days after discharge, with the 30-day interval being the primary prespecified outcome. Control vs Intent-to-Treat vs Per Protocol population reported.

  30 days after emergency department discharge

• Time to Any Follow up (in Person or Phone) With PCP, Specialists, or Urgent Care

  Follow-up visits, abstracted from participant medical records, included office visits with primary or specialty providers, telephone calls, and online patient portal messaging (excluding automated reminder messages, electronic messages that did not receive a patient response, laboratory testing, and previously scheduled outpatient procedures). Outpatient follow-up was dichotomized by whether or not any contact with outpatient providers occurred within either 7 or 30 days of discharge. This approach allowed us to differentiate follow-up occurring soon after discharge (consistent with most ED discharge instructions) from less-timely contact with outpatient clinics. To conduct a preplanned subanalysis, we also categorized all follow-up as either "in-person" or "electronic." Dichotomous variables were created for each modality at each time point as well as a combined variable representing all forms of contact. Control vs Intent-To-Treat vs Per Protocol population reported.

  Medical records reviewed for number of participants who followed up within 7 and 30 days, augmented by participant surveys at day 4 and 30 to learn about non-University of Wisconsin hospital visits

• Number of Participants With Urgent Care or Unplanned Hospitalizations Within 30 Days of ED Discharge

  Control vs Intent-to-Treat vs Per Protocol Population reported

  up to 30 days

Secondary Outcomes (4)

• Number of Participants With Medication Changes Implemented

  day 4

• Number of Participants Who Could Recall Any Specific Red Flag

  day 4

• Level of Participant Activation as Measured by the Perceived Health Competence Survey

  30 days after emergency department discharge

• Median Cost of Healthcare Services Within 30 Days of the Original ED Visit

  30 days after emergency department discharge

Other Outcomes (3)

• Program Satisfaction Survey Score

  day 1, day 30

• Family Caregiver Activation in Transitions (FCAT)

  day 1, day 30

• Number of Participants Who Died Within 30 Days of Discharge

  up to 30 days

Study Arms (2)

Usual Care

NO INTERVENTION

Older adults discharged from an ED to home who receive the usual processes and services.

Care Transitions Intervention

ACTIVE COMPARATOR

Older adults discharged from an ED to home who receive the Care Transitions Intervention.

Behavioral: Care Transitions Intervention

Interventions

Care Transitions Intervention BEHAVIORAL

The Care Transitions Intervention uses coaches, in this case paramedics, to support patients being discharged home by transferring skills to activate patients.

Care Transitions Intervention

Eligibility Criteria

• Age: 60 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age≥60 years
• English speaking
• Monroe County, New York or Dane County, Wisconsin resident
• University of Wisconsin or University of Rochester affiliated primary care physician
• Community dwelling (no prisoners, nursing home, assisted living residents)
• Discharge home from the ED

You may not qualify if:

• Previous study participation
• Discharged to hospice
• Homelessness
• Followed by transition care team (e.g., from recent hospitalization)
• Followed by intensive case management program
• Emergency Severity Index 1 patients (highest acuity, as assigned by ED triage staff)
• Unable to obtain consent from patient or proxy

Sponsors & Collaborators

• University of Wisconsin, Madison: lead
• National Institute on Aging (NIA): collaborator

Study Sites (2)

University of Rochester Medical Center

Rochester, New York, 14642, United States

Location

University of Wisconsin

Madison, Wisconsin, 53705, United States

Location

Related Publications (1)

• Mi R, Hollander MM, Jones CMC, DuGoff EH, Caprio TV, Cushman JT, Kind AJH, Lohmeier M, Shah MN. A randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisits. BMC Geriatr. 2018 May 3;18(1):104. doi: 10.1186/s12877-018-0792-5.

  PMID: 29724172 DERIVED

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

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

Results Point of Contact

• Title: Manish N. Shah, MD, MPH
• Organization: UW School of Medicine and Public Health

mnshah@medicine.wisc.edu

608-263-6690

Study Officials

• Manish N Shah, MD, MPH

  University of Wisconsin, Madison

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 6, 2015
• First Posted: August 13, 2015
• Study Start: February 3, 2016
• Primary Completion: July 31, 2019
• Study Completion: November 30, 2019
• Last Updated: July 22, 2022
• Results First Posted: July 22, 2022

Record last verified: 2022-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)