Coordinated Emergency Department Transitions

NCT06933849 | Completed Results DMC

• 2 other identifiers: U54AG063546_Pilot Cycle 5AU54AG063546
• Study Type: interventional
• Target: 1,376
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this observational study is to learn the feasibility, acceptability, appropriateness, and adherence to a case management intervention. PartnerED is a case management intervention that aims to reduce unnecessary hospital admissions by providing real-time, structured information and discharge support to emergency department providers via phone and fax. The intervention is led by chronic care managers employed by Bluestone Accountable Care Organization, a physician group primarily serving patients in assisted living centers.

Conditions

Alzheimer Disease or Associated Disorder

Keywords

case management; emergency department; feasibility

Outcome Measures

Primary Outcomes (1)

• Percent of Eligible Emergency Department Visits With Completed Outreach

  Percent of eligible emergency department visits in which a case manager provided structured clinical and discharge support information to a emergency department provider about a patient who was in their care, with the goal of avoiding an unnecessary hospitalization

  Within 1-3 hours of emergency department registration

Secondary Outcomes (1)

• Percent of Successful Outreach Conversations in Which Staff Reported Avoidance of an Unnecessary Hospitalization

  Within 24 hours of emergency department registration

Study Arms (1)

All patients with eligible emergency department visits

EXPERIMENTAL

Eligible emergency department visits were identified using electronic admission, discharge, and transfer notifications

Behavioral: Structured case management

Interventions

Structured case management BEHAVIORAL

When a Bluestone Accountable Care Organization registers in an emergency department, a Bluestone chronic care manager contacts emergency department clinicians by phone and fax to provide up-to-date clinical and discharge support information.

All patients with eligible emergency department visits

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Bluestone Accountable Care Organization patient
• Registration in emergency department between November 1, 2023 and June 30, 2024, as recorded in electronic admission, discharge, and transfer notifications

You may not qualify if:

• None

Sponsors & Collaborators

• Brown University: lead
• National Institute on Aging (NIA): collaborator

Study Sites (1)

Bluestone Accountable Care Organization

Omaha, Nebraska, 68154, United States

Location

MeSH Terms

Conditions

Alzheimer Disease; Emergencies

Condition Hierarchy (Ancestors)

Dementia; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Tauopathies; Neurodegenerative Diseases; Neurocognitive Disorders; Mental Disorders; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Results Point of Contact

• Title: Ellen McCreedy
• Organization: Brown University

ellen_mccreedy@brown.edu

(401) 863-7345

Study Officials

• Ellen McCreedy, PhD, MPH

  Brown University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: March 30, 2025
• First Posted: April 18, 2025
• Study Start: October 4, 2024
• Primary Completion: February 18, 2025
• Study Completion: March 30, 2025
• Last Updated: May 27, 2026
• Results First Posted: March 3, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)