Practical Alternative to Hospitalization

NCT04639102 | Completed

• 1 other identifier: 844436
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

The investigators test the PATH program to evaluate whether the program allows patients to spend more days at home in comparison to patients who receive regular care. The program will involve patients from Penn Presbyterian Medical Center with a set of diagnoses and will provide patients with enhanced services upon discharge from the emergency department.

Conditions

Emergency Department; Health, Subjective; Health Care Utilization

Outcome Measures

Primary Outcomes (2)

• Days at home over 30 days

  The number 30 minus the amount of days that patients spend in a hospital, nursing facility, or ED after discharge from the initial ED visit

  30 days

• Days that patients are expired

  The number of days that patients are expired

  30 days

Secondary Outcomes (5)

• Impact of PATH on hospital operations - Capture rate

  5 months

• Quality of life at 30 days

  5 months

• Functional status at 30 days

  5 months

• Estimated cost (allowed charges) based on healthcare utilization

  5 months

• Impact of PATH on hospital operations - percentage of hospitalized patients

  5 months

Study Arms (2)

PATH Intervention

EXPERIMENTAL

Patients in the treatment arm will receive a personalized plan of care upon discharge from the emergency department.

Other: PATH Intervention

Routine Care

NO INTERVENTION

Patients in the control arm will receive standard-of-care services (the care plan that the emergency physician would normally offer if PATH were not available) without PATH enrollment.

Interventions

PATH Intervention OTHER

Patients will receive an enhanced level of care and service: 1. Discharge planning- PATH clinicians will develop an individualized treatment plan at time of ED discharge. Each patient will receive next-day phone call to monitor status. There will be additional patient and family education, triage of new or worsening symptoms, and additional telephone contact as determined in treatment plan. There will be communication with home health teams as needed. 2. Care coordination- PATH clinicians will arrange necessary primary medical doctor and specialty appointments. They will also communicate treatment plan to outpatient provider and arrange transportation for patients. 3. Home monitoring/ Home Health Services- If patients are eligible and consent to home health services, they will be enrolled in Penn Medicine Home Health (PMHH). This will include virtual home monitoring, skilled nurse care, home physical and occupational therapists, social work services, and wound care.

PATH Intervention

Eligibility Criteria

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

You may qualify if:

• Stable (Patients are deemed stable by ED clinician and PATH clinician per review of vital signs, history, exam, test results, and functional status)
• Have active insurance
• Domiciled at home (Patients must live in the community and not in nursing facility, shelter, or otherwise homeless)
• Safe home environment
• Live in Penn Medicine Home Health (PMHH) geographic catchment if enrolled in PMHH services

You may not qualify if:

• Substance use disorder (No active untreated SUD, including alcohol, opioids, cocaine, or stimulants)
• Serious mental health condition
• Police custody
• Homelessness
• Anticipated procedures or surgeries
• IV access (Patients with need for home infusion services or frequent blood testing after discharge must have standard level of IV access)

Sponsors & Collaborators

• University of Pennsylvania: lead
• Independence Blue Cross: collaborator

Study Sites (1)

University of Pennsylvania

Philadelphia, Pennsylvania, 19104, United States

Location

MeSH Terms

Conditions

Emergencies; Patient Acceptance of Health Care

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Treatment Adherence and Compliance; Health Behavior; Behavior

Study Officials

• Austin Kilaru, MD, MSHP

  University of Pennsylvania

  PRINCIPAL INVESTIGATOR

Study Design

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

Study Record Dates

• First Submitted: November 16, 2020
• First Posted: November 20, 2020
• Study Start: February 9, 2021
• Primary Completion: July 2, 2021
• Study Completion: July 2, 2021
• Last Updated: August 10, 2022

Record last verified: 2022-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)