Post-Acute Physician Home Visit Program

NCT03178513 | Completed

• 1 other identifier: P000719
• Study Type: interventional
• Target: 51
• Locations: 1 country
• Sites: 2

Brief Summary

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.

Conditions

A Patient Discharged From an Acute-care Hospital Who Had an Acute Illness

Outcome Measures

Primary Outcomes (1)

• New or worsening symptoms

  "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

Secondary Outcomes (9)

• Total cost, 30-days post discharge

  Day of discharge to 30 days later

• Total reimbursement, 30-days post discharge

  Day of discharge to 30 days later

• 3-item Care Transition Measure, score

  30 days after discharge

• Primary care provider follow-up within 14 days, y/n

  Day of discharge to 14 days later

• Ability to carry out the discharge plan, score

  30 days after discharge

Other Outcomes (31)

• Global satisfaction with care, score

  30 days after discharge

• Days at home since discharge, #

  30 days after discharge

• All-cause 30-day readmission(s) after index hospitalization, y/n

  30 days after discharge

Study Arms (2)

Home visit

EXPERIMENTAL

A participant in this arm will receive a home visit after discharge from the hospital.

Other: Home visit

Usual Care

NO INTERVENTION

A participant in this arm will not receive a home visit after discharge from the hospital.

Interventions

Home visit OTHER

The visit will be entirely patient tailored, last approximately one hour, and at a minimum will entail: * Medical assessment * Psychosocial assessment * Medication reconciliation * Follow-up of inpatient primary team's specific recommendations * Follow-up, as needed, with primary care team or inpatient team

Home visit

Eligibility Criteria

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

You may qualify if:

• 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

You may not qualify if:

• Undomiciled
• In police custody
• Domestic violence screen positive

Sponsors & Collaborators

• Brigham and Women's Hospital: lead

Study Sites (2)

Brigham and Women's Hospital

Boston, Massachusetts, 02115, United States

Location

Brigham and Women's Faulkner Hospital

Boston, Massachusetts, 02130, United States

Location

Related Publications (6)

• 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.

  PMID: 17431881 BACKGROUND

• 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.

  PMID: 19217498 BACKGROUND

• 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.

  PMID: 9400040 BACKGROUND

• 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.

  PMID: 23978408 BACKGROUND

• 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.

  PMID: 27631713 BACKGROUND

• 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.

  PMID: 19786916 BACKGROUND

MeSH Terms

Interventions

House Calls

Intervention Hierarchy (Ancestors)

Professional Practice; Organization and Administration; Health Services Administration

Study Officials

• Jeffrey Schnipper, MD MPH

  Brigham and Women's Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: June 5, 2017
• First Posted: June 7, 2017
• Study Start: June 6, 2017
• Primary Completion: January 20, 2018
• Study Completion: January 20, 2018
• Last Updated: August 13, 2019

Record last verified: 2019-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)