Counter-referral System Improvement Collaborative

NCT03775551 | Completed

• 2 other identifiers: C-RG-E1560-P00220180328
• Study Type: interventional
• Target: 510
• Locations: 1 country
• Sites: 10

Brief Summary

Coordination between different levels of care has been identified as one of the main components of care among people with chronic diseases. In this sense, an adequate referral and counter-reference system facilitates the management of the care process with timely access to the required referral. The objective of this project is to evaluate the effectiveness of a multicomponent strategy that improves the counter- referral process in patients with cardiovascular diseases in the public health system. Population: The study will be carried out in selected hospitals of the provinces of Mendoza, Tucumán and Salta in Argentina. Patients who have been hospitalized with a diagnosis of heart failure, hypertension (requires hospitalization) and / or coronary disease (unstable angina) will be included. Design and methods: a Randomized clinical study by clusters. 10 hospital will be included: 5 will be randomly assigned to receive an intervention to increase the improve counter referral rates (improvement cycles) and 5 to the control branch (usual care). 51 participants will be included in each hospital, in total, 510 participants. Intervention: An innovative vision is proposed, which combines a participatory and dynamic methodology based on improvement cycles. This approach includes the implementation of participatory learning sessions for health providers, involving the effectors of the design of the intervention. In the intervention branch at least 6 workshops (sessions) will be held with the members of the care system, in order to identify opportunities for improvement oriented to the design and application of an innovative intervention based on best practices. Each one of the sessions will constitute an analysis of the improvement cycle, following the following steps: 1) Selection of participants of the initial workshop; 2) Development of work model based on bibliographic review and initial qualitative phase; 3) Initial workshop with effectors for training in continuous improvement, objectives, interventions and data collection; 4) Learning workshops to discuss results, applicability of interventions and modifications to the work plan; 5) Closing session to evaluate preliminary results and discuss continuity of interventions beyond the project. Outcomes: 1) consultation in the PHC after hospital discharge; 2) readmission's; 3) consultations in the hospital; 4) follow-up in the PHC; 5) patient perspective (satisfaction).

Conditions

Cardiovascular Diseases; Quality Improvement

Keywords

quality improvement; collaborative; counter reference

Outcome Measures

Primary Outcomes (1)

• Patients visits in a primary health center (PHC) after hospital discharge

  proportion of visits made in a primary care center (PHC) after hospital discharge

  3 months after enrollment and/or end of study

Secondary Outcomes (5)

• Effective counter reference performed by physicians

  3 months after enrollment and/or end of study

• Time to the first consultation in a PHC after the hospital discharge

  3 months after enrollment and/or .end of study

• Cardiovascular hospital readmission's

  3 months after enrollment and/or end of study

• Cardiovascular re consultations at the second level of care

  3 months after enrollment and/or end of study

• Patients satisfaction with the primary health level measured by adapted PCAT questions

  4 months

Study Arms (2)

Control

NO INTERVENTION

The participants belonging to the hospitals assigned to the control group the health providers will give feedback on their health condition and will advise on how to follow up their care after discharge or referral back to PHC following usual practice.

Improvement cycle

EXPERIMENTAL

In participants belonging to the hospitals assigned to the intervention group,the health providers will give feedback on their health condition and will advise on how to follow up their care after discharge or referral back to PHC using innovative intervention to assure continuity of care and assistant level approach. This innovations will be crafted from the rapid improvement cycles considering the environment and key aspects of the every day care at the participating centers.

Behavioral: Improvement cycle

Interventions

Improvement cycle BEHAVIORAL

at least 6 workshops (sessions) will be held with the members of the care system, in order to identify opportunities for improvement oriented to the design and application of an innovative intervention based on best practices.

Also known as: quality improvement cycle

Improvement cycle

Eligibility Criteria

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

You may qualify if:

• Subjects that only have public health coverage or PAMI
• Adults over 18 year of age
• Patients admitted to the hospital with diagnosis of: non valvular heart failure and/or complicated hypertension ( that requires hospitalization) and/or coronary heart disease ( unstable angina)
• Residence in the area of influence of the hospitals

You may not qualify if:

• Pregnant women
• Anticoagulated patients
• People who are immobilized
• People who do not give their informed consent
• People who plan to move in the next 3 months

Sponsors & Collaborators

• Institute for Clinical Effectiveness and Health Policy: lead
• Ministry of Public Health, Argentina: collaborator

Study Sites (10)

Hospital A Italo Perrupato

San Martín, Mendoza Province, Argentina

Location

Hospital Teodoro J. Schestakow

San Rafael, Mendoza Province, Argentina

Location

Hospital Antonio J. Scaravelli

Tunuyán, Mendoza Province, Argentina

Location

Hospital N. Joaquín Castellano

General Güemes, Salta Province, Argentina

Location

Hospital Centro de Salud Zenón J. Santillán

San Miguel de Tucumán, Tucumán Province, Argentina

Location

Hospital Ángel C. Padilla

San Miguel de Tucumán, Tucumán Province, Argentina

Location

Hospital Central

Mendoza, Argentina

Location

Hospital Luis Lagomaggiore

Mendoza, Argentina

Location

Hospital Papa Francisco

Salta, Argentina

Location

Hospital San Bernardo

Salta, Argentina

Location

MeSH Terms

Conditions

Cardiovascular Diseases

Study Officials

• Vilma Irazola, MD

  Institute for Clinical Effectiveness and Health Policy

  PRINCIPAL INVESTIGATOR

• Ezequiel García Elorrio, PhD

  Institute for Clinical Effectiveness and Health Policy

  PRINCIPAL INVESTIGATOR

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: December 6, 2018
• First Posted: December 14, 2018
• Study Start: June 8, 2018
• Primary Completion: December 1, 2019
• Study Completion: December 1, 2019
• Last Updated: April 23, 2024

Record last verified: 2024-04

Locations

AR (10)