Emergency Care at Home

NCT06299774 | Completed

• 1 other identifier: 2023P003383
• Study Type: interventional
• Target: 229
• Locations: 1 country
• Sites: 1

Brief Summary

This study will assess the efficacy of receiving emergency care at home versus in the brick-and-mortar emergency department.

Conditions

Emergency Medical Services; Emergency Department Visits

Outcome Measures

Primary Outcomes (1)

• Participant with an emergency department presentation, observation, or hospitalization within 9 days

  Whether a patient presented to the emergency department, was observed in the emergency department, or was hospitalized in the 9 days following their index emergency care visit. Excludes patients who were admitted on their index visit.

  From the day after emergency care visit until 9 days later, up to 9 days

Secondary Outcomes (3)

• Time to care initiation

  From the time a consultation is placed in the electronic health record to the time a patient is seen by a clinician, up to 2880 minutes.

• Time spent receiving care

  From the time a patient is seen by a clinician to the time a patient completes their emergency care, up to 1440 minutes.

• Number of days at home within 9 days

  From the day after emergency care visit until 9 days later

Study Arms (2)

Usual care

ACTIVE COMPARATOR

Emergency care in a brick-and-mortar emergency department.

Other: Emergency care at a brick-and-mortar emergency department

Emergency care at home

EXPERIMENTAL

Emergency care in the patient's home.

Other: Emergency care at home

Interventions

Emergency care at a brick-and-mortar emergency department OTHER

Standard emergency care delivered in a brick-and-mortar emergency department.

Usual care

Emergency care at home OTHER

A mobile integrated health paramedic under the direction of a remote emergency care physician will arrive at the patient's home and deliver emergency care.

Emergency care at home

Eligibility Criteria

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

You may qualify if:

• Age \>= 18 years
• Resides within Home Hospital geographic area
• Lives in permanent housing (i.e., not in temporary housing such as a shelter)
• Patient of a Mass General Brigham primary care provider
• Primary care provider attests that their triage recommendation is the emergency department
• Emergency care at home nurse triages the participant to the emergency department or urgent care
• Patient attests that they intend to go to the emergency department

You may not qualify if:

• Insurance: workers compensation and motor vehicle accident
• Lives in a healthcare facility (Skilled Nursing, Rehab, long term acute care)
• Patient/caregiver cannot answer phone or door
• Active substance use
• Acute psychiatric concerns (e.g., suicidal ideation, even if passive)
• Home safety concerns (e.g., intimate partner violence)
• High-risk features:
• oHigh Risk Signs, if available: Heart rate \> 120 Systolic blood pressure \< 90 Shock Index (heart rate divided by systolic blood pressure) \> 1 Oxygen \< 93% on ambient air Increase in oxygen requirement new or \> 2 liters Respiratory rate \> 28 Diaphoresis oHigh Risk Symptoms: Active chest pain Severe work of breathing Syncope Hemoptysis Seizure Other concerning symptom per nurse triage
• Requires inpatient-level care
• Requires specialty consultation
• Requires physical, occupational, or speech therapy
• Requires blood transfusion
• Requires internal physical exam maneuver (e.g. rectal exam, genitourinary exam)
• Requires imaging that is not available at home
• Requires monitoring that is not available at home

Sponsors & Collaborators

• Brigham and Women's Hospital: lead

Study Sites (1)

Massachusetts General Hospital

Boston, Massachusetts, 02114, United States

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Physician

Study Record Dates

• First Submitted: February 26, 2024
• First Posted: March 8, 2024
• Study Start: February 2, 2024
• Primary Completion: October 26, 2024
• Study Completion: October 26, 2024
• Last Updated: March 17, 2026

Record last verified: 2024-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)