Care Transition Patient Experience Study With Electronic Tool

NCT03970174 | Unknown

• 1 other identifier: 828
• Study Type: interventional
• Target: 240
• Locations: 1 country
• Sites: 1

Brief Summary

Patients being admitted to hospital are becoming more complex and they often require a team of health professionals (doctors from different disciplines, nurses, and allied health professionals) working together to meet their needs. Effective communication among this team and with patients is essential to providing high quality patient-centered care. Care Connector is an electronic tool that was developed to help health professionals communicate about patient care with each other. It also incorporates best practice whenever possible (such as the used of Patient Oriented Discharge Summary \[PODS\] developed at University Health Network) during care transitions. We want to understand whether using electronic tools can address the communication issues faced by patients/families, and whether they impact on repeat visits to the Emergency Department or the hospital after discharge. In this study, we will be asking patients and families who have recently been discharged from hospital to describe their experience with communication and care transitions through a brief telephone survey. All of them will be discharged from units where Care Connector was used. However, some of the units would have used the PODS feature while others will not. A small group will also be invited to participate in an in-depth telephone interview. The results of this study will be used to improve Care Connector and to enhance communication and patient experience in general.

Conditions

Care Transition; Communication

Keywords

Patient experience

Outcome Measures

Primary Outcomes (1)

• Care transition measure 3

  This is a validated measure developed by Coleman et al (Med Care. 2008 Mar;46(3):317-22) to measure quality of care transitions. It contains 3 questions (please see reference for questions).

  Up to 30 days post discharge

Secondary Outcomes (6)

• In-hospital communication

  Up to 30 days post discharge

• ED visit

  30 days post discharge

• Hospitalization

  30 days post discharge

• Presence of follow up plan in discharge summary

  At the time of patient discharge (0 days)

• Proportion of appointments with date/time confirmed at discharge

  At time of patient discharge (0 days)

Other Outcomes (1)

• Subgroup analysis of patients with dementia

  Up to 30 days post patient discharge

Study Arms (2)

Intervention

EXPERIMENTAL

Two of the 4 Medicine wards will have implemented the care transition module of Care Connector

Other: Care Connector care transition module

Control

NO INTERVENTION

Remaining 2 of 4 Medicine wards will use all other aspects of Care Connector (except for care transition module)

Interventions

Care Connector care transition module OTHER

Care Connector is an electronic interprofessional communication and collaboration tool. Its features include Physician Sign-Out, documentation, interprofessional care planner, messaging, and flow planner. The newest module is a care transition module which allows physicians to electronically generate discharge summaries as well as incorporation of allied health recommendation, but also will pull information into the PODS (Patient Oriented Discharge Summary) format designed by University Health Network. This results in a patient friendly discharge instruction sheet that can be provided to patient. The intervention arm will have access to the care transition feature, while the control wards do not.

Intervention

Eligibility Criteria

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

You may qualify if:

• General medical patients cared for and discharged by the Hospitalist service
• Be 18 years of age and above
• Length of stay for hospitalization is at least 48 hours
• The discharge destination is home (with or without support), or retirement home
• Has the cognitive ability to, or has a substitute decision maker (SDM) (if patient is not capable) able to, provide informed consent for this research study
• Can be contacted by telephone up to 30 days post discharge
• Able to respond to survey questions over telephone (assistance from family member or other caregiver at the time of telephone survey is permitted)

You may not qualify if:

• Discharged from a non-Medicine ward (e.g. medicine patient bed spaced to a surgical ward) or from the Emergency Department directly
• Previously participated in this study (in case of re-admission)
• Died in hospital
• Unable to give informed consent due to language barrier and lack of suitable assistance from family members and/or caregivers and/or SDM (if patient is not capable)
• Cannot be contacted by telephone after discharge
• Unable to respond to telephone survey questions for any reason (e.g. hearing impairment, language barrier) and lack of availability of family members and/or other caregivers willing and able to provide assistance

Sponsors & Collaborators

• Trillium Health Partners: lead
• Centre for Aging and Brain Health Innovation: collaborator

Study Sites (1)

Trillium Health Partners

Mississauga, Ontario, L5M 2N1, Canada

Location

Related Publications (3)

• Hahn-Goldberg S, Okrainec K, Huynh T, Zahr N, Abrams H. Co-creating patient-oriented discharge instructions with patients, caregivers, and healthcare providers. J Hosp Med. 2015 Dec;10(12):804-7. doi: 10.1002/jhm.2444. Epub 2015 Sep 25.

  PMID: 26406116 BACKGROUND

• Parry C, Mahoney E, Chalmers SA, Coleman EA. Assessing the quality of transitional care: further applications of the care transitions measure. Med Care. 2008 Mar;46(3):317-22. doi: 10.1097/MLR.0b013e3181589bdc.

  PMID: 18388847 BACKGROUND

• Tang T, Lim ME, Mansfield E, McLachlan A, Quan SD. Clinician user involvement in the real world: Designing an electronic tool to improve interprofessional communication and collaboration in a hospital setting. Int J Med Inform. 2018 Feb;110:90-97. doi: 10.1016/j.ijmedinf.2017.11.011. Epub 2017 Nov 22.

  PMID: 29331258 BACKGROUND

Related Links

• Canadian Patient Experiences Survey - Inpatient Care (Canadian Institute for Health Information)

MeSH Terms

Conditions

Communication

Condition Hierarchy (Ancestors)

Behavior

Study Officials

• Terence Tang, MD

  Trillium Health Partners

  PRINCIPAL INVESTIGATOR

Study Design

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

Model Details: Care Connector care transition module will be rolled out at 2 of 4 wards (intervention) while the other 2 wards will have usual care

Study Record Dates

• First Submitted: May 9, 2019
• First Posted: May 31, 2019
• Study Start: February 2, 2018
• Primary Completion: July 31, 2019
• Study Completion: June 30, 2020
• Last Updated: March 11, 2020

Record last verified: 2020-03

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)