Nurse-Led Discharge Program and Primary Care Outcomes: A Proof-of-concept Cluster Randomized Controlled Trial

NCT07458841 | Not Yet Recruiting

• 1 other identifier: currently not available
• Study Type: interventional
• Target: 120
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this cluster randomized controlled trial is to evaluate whether a nurse-led primary health care (PHC) discharge intervention can improve patient activation and primary health care-related outcomes among hospitalized adult patients after discharge.

Conditions

Primary Healthcare

Keywords

nurse-led discharge intervention; primary healthcare; cluster randomized controlled trail

Outcome Measures

Primary Outcomes (1)

• The primary outcome is the change in the Patient Activation Measure (PAM) between baseline and 3-month follow-up.

  The PAM is a 13-item self-report questionnaire to measure patient activation level \[18\]. Patients can go through four levels of activation: (1) disengaged and overwhelmed, (2) becoming aware but still struggling, (3) taking action, and (4) maintaining behaviors and pushing further \[18\].PAM raw score can be calculated by adding all of the responses to the 13 questions \[18\]. This score is then converted into an activation score ranging from 0 = no activation to 100 = high activation using a scoresheet provided by Insignia Health.

  From baseline to 3-month follow up.

Study Arms (2)

Intervention group

EXPERIMENTAL

1. primary healthcare discharge education 2. specially-designed health education leaflet 3. patient discharge package

Behavioral: Primary healthcare discharge education; Behavioral: specially-designed health education leaflet; Behavioral: Patient discharge package

Control Group

ACTIVE COMPARATOR

usual hospital discharge practice

Behavioral: usual hospital discharge practice

Interventions

Primary healthcare discharge education BEHAVIORAL

The primary healthcare discharge education begins by identifying priorities to address related to patients' life situations (using the Instrument for Patient Capacity Assessment) and determining the patient's current level of activation (using the Patient Activation Measure). A discharge education guide developed by the research team helps to individualize the teaching according to the patient's priorities and activation level.

Intervention group

specially-designed health education leaflet BEHAVIORAL

1. Introduction of the District Health Centres/Expresses; 2. Life Course Preventive Care Plan pamphlet; 3. Provide disease-specific discharge/rehabilitation advice and relevant health education materials with an emphasis on prevention and self-care management; 4. The hospital nurses will help discharge patients download and install the "HA Go" mobile app.

Intervention group

Patient discharge package BEHAVIORAL

Subjects in the intervention group will receive the following items with instructions for use upon hospital discharge: 1. Blood pressure monitor 2. Blood glucose test strip 3. Soft ruler to measure weight circumference 4. Resistance bands for simple exercise

Intervention group

usual hospital discharge practice BEHAVIORAL

The control group will receive the usual hospital discharge practice upon discharge.

Control Group

Eligibility Criteria

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

You may qualify if:

• Hong Kong residents aged ≥18 years
• Able to read and communicate in Chinese (Cantonese or Mandarin)
• Being hospitalized for more than 24 hours
• Stable medical condition upon hospital discharge

You may not qualify if:

• Having a history of psychiatric/psychological disease or currently on regular psychotropic medications
• Currently participating in other primary healthcare programmes

Sponsors & Collaborators

• The University of Hong Kong: lead
• Queen Mary Hospital, Hong Kong: collaborator

Study Sites (1)

18/F, Metro South Tower 1, 39 Wong Chuk Hang Road, Wong Chuk Hang, Hong Kong

Hong Kong, Hong Kong, 000000, Hong Kong

Location

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Study Officials

• Siu Long Chau, PhD

  HKU

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Siu Long Chau, PhD

CONTACT

+852 6700 9987; cslmatt@hku.hk

Study Design

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

Study Record Dates

• First Submitted: March 4, 2026
• First Posted: March 9, 2026
• Study Start: March 1, 2026
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): June 1, 2027
• Last Updated: March 9, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)