Quasi-Randomized Evaluation of the UCLA Next Day Clinic (NDC)

NCT06526884 | Active Not Recruiting

• 1 other identifier: 24-000913
• Study Type: interventional
• Target: 1,080
• Locations: 1 country
• Sites: 1

Brief Summary

The Next Day Clinic (NDC) is a quality improvement initiative that will be launched and operated by UCLA Health starting July 22, 2024. Its goals are to improve patient care and safety and to maximize cost effectiveness. The way it does this is by identifying patients in the ED who would normally be admitted for low-acuity conditions, and diverting them to a high-acuity clinic the following day called the NDC. This will help decompress the ED and the hospital, and allow for overall higher quality care. The Health System has partnered with UCLA's Healthcare Value Analytics and Solutions \[UVAS\] group which specializes in these types of program evaluations. The analysis conducted by the study team will be used to directly inform NDC operations, scaling, and future plans.

Conditions

Pyelonephritis; AKI - Acute Kidney Injury; Diabetic Foot Infection; Osteomyelitis; Pneumonia; Syncope; Congestive Heart Failure; Cellulitis

Keywords

Patient safety; Cost effectiveness; Avoidable hospitalizations

Outcome Measures

Primary Outcomes (1)

• Days alive and out of hospital (DAOH)

  Cumulative number of days alive and not admitted or boarding in a hospital or emergency department

  30 days from index ED visit

Secondary Outcomes (6)

• Global health-related quality of life

  30 days from index ED visit

• Patient experience

  30 days from index ED visit

• Financial analysis

  Through study completion, an average of 12 months

• Cost effectiveness analysis

  Through study completion, an average of 12 months

• Hospitalizations avoided

  Through study completion, an average of 12 months

Study Arms (2)

ED-initiated hospitalization

NO INTERVENTION

Patients with odd birthdays will be routed to standard-of-care ED-initiated hospitalization pathways.

Next Day Clinic

EXPERIMENTAL

Patients with even birthdays who meet inclusion criteria will be given the option to receive care in the Next Day Clinic to avoid hospitalization.

Other: Next Day Clinic

Interventions

Next Day Clinic OTHER

A dedicated Next Day Clinic team consisting of a clinician and nurse case manager will provide care and specialist referrals to patients within 24 hours of an ED visit that would have resulted in hospitalization without this novel hospital avoidance initiative.

Next Day Clinic

Eligibility Criteria

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

You may qualify if:

• years of age or older
• About to be admitted through the ED for one of the NDC diagnoses or a synonym (per Study Protocol document), defined by the presence of a Plan to Admit order or Bed Request order, OR recently admitted under observation or inpatient status for one of the NDC diagnoses.
• Identified as at-risk for an avoidable hospitalization in the ED based on a pre-determined set of lab and vital parameters.
• Insurance that authorizes the patient to follow-up at UCLA Health, or self-pay
• Admitted or being admitted to an internal medicine service

You may not qualify if:

• Heart or lung transplant recipient with concern for graft dysfunction
• Pregnant
• Enrolled in hospice
• Admitted to a critical care service
• ED deems discharge unsafe due to complex social or medical factors
• Active malignant cancer (per Council of State and Territorial Epidemiologists value set)
• Pulmonary arterial hypertension (per Joint Commission value set)
• Undergoing workup for solid organ transplant
• Interstitial lung disease (including pulmonary fibrosis) (per Higher Level 7 value set)
• Requiring inpatient procedure or surgery defined by the presence of an anesthesia event or operating room encounter.
• The ED deems discharge unsafe due to complex social or medical factors.
• Transferred to an ineligible hospital
• Note:
• The Health System plans to limit the volume of referrals to the NDC by only referring patients who have an even birth date (this is more equitable than first-come-first-serve, because wage workers are more likely to come to the ED later in the day; even/odd birth date theoretically keeps more spots open for patients presenting to the ED later).

Sponsors & Collaborators

• University of California, Los Angeles: lead

Study Sites (1)

Ronald Reagan UCLA Medical Center

Los Angeles, California, 90024, United States

Location

MeSH Terms

Conditions

Pneumonia; Syncope; Heart Failure; Cellulitis; Pyelonephritis; Acute Kidney Injury; Osteomyelitis

Condition Hierarchy (Ancestors)

Respiratory Tract Infections; Infections; Lung Diseases; Respiratory Tract Diseases; Unconsciousness; Consciousness Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Heart Diseases; Cardiovascular Diseases; Skin Diseases, Infectious; Suppuration; Connective Tissue Diseases; Skin and Connective Tissue Diseases; Inflammation; Pathologic Processes; Nephritis, Interstitial; Nephritis; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Pyelitis; Male Urogenital Diseases; Renal Insufficiency; Bone Diseases, Infectious; Bone Diseases; Musculoskeletal Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: Randomized encouragement trial

Study Record Dates

• First Submitted: July 17, 2024
• First Posted: July 30, 2024
• Study Start: July 22, 2024
• Primary Completion: January 20, 2026
• Study Completion: April 1, 2026
• Last Updated: March 18, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)