Efficacy of a Web-based Seamless Discharge Tool

The recruitment status of this study is unknown because the information has not been verified recently.
Verified October 2010 by Ward of the 21st Century.
Recruitment status was  Not yet recruiting
Sponsor:
Collaborators:
Canadian Institutes of Health Research (CIHR)
AHS Cancer Control Alberta
Information provided by:
Ward of the 21st Century
ClinicalTrials.gov Identifier:
NCT01402609
First received: July 25, 2011
Last updated: NA
Last verified: October 2010
History: No changes posted
  Purpose

The transition between acute care and community care represents one of the most vulnerable periods in health care delivery, particularly as the complexity of inpatient populations increases. Two recent North American studies found an incidence of post-discharge adverse events between 19-23%, with adverse drug events accounting for 66-72% of these. The vulnerability of this period has been attributed mainly to a failure of care providers to adequately reconcile discrepancies between home medications and discharge medications, as well as a failure to transfer this and other important information about the hospitalization and discharge to community care providers. While discharge communication with the primary care physician has traditionally occurred via a handwritten or dictated summary, major deficits exist with respect to timeliness of information transfer and adequacy of content in discharge summaries.

Computer-enabled discharge communications can potentially avert such problems. This is particularly true for web-based solutions that do not require end users to acquire additional software/training to use them. The purpose of this research is to definitively assess the efficacy of a web-based seamless discharge communication tool that the Medical Ward of the 21st Century (W21C - see www.w21c.org) team in Calgary has developed through iterative consultation with multiple clinical stakeholders as well as patients/families. This tool has great potential to be implemented on a provincial level as well as across Canada and internationally because it operates on a web interface that does not confine its applicability to a single type of hospital information system.

The purpose of this research is to definitively assess the efficacy of the web-based discharge communication tool that our team has developed in partnership with Alberta Health Services. In doing so, our specific objective will be to answer the following research questions:

  1. Is the seamless discharge communication tool efficacious with respect to reducing hospital readmission and mortality (at 3 months), as well as reducing adverse events and adverse drug events?
  2. Does the seamless discharge communication tool transfer appropriate, complete, and accurate discharge information in a timely manner compared to traditional discharge communication?
  3. Is the seamless discharge communication tool efficacious with respect to improving physician and patient satisfaction?

Condition Intervention
Acute Exacerbation of Chronic Obstructive Airways Disease
Procedure: seamless discharge
Procedure: Usual care

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Health Services Research
Official Title: Efficacy of a Web-based Seamless Discharge Tool

Resource links provided by NLM:


Further study details as provided by Ward of the 21st Century:

Primary Outcome Measures:
  • readmission to hospital [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
    The primary outcomes are identified as such because these are recognized to be major events that we are ultimately trying to prevent through safer health care. The 3 month time frame is felt to be most relevant, because it is short enough to potentially relate to discharge communications, but also long enough after discharge to permit some events to occur. The primary outcomes of interest will be assessed through existing linkages to hospitalization data from the Alberta Health Services Health Outcomes Group based in Calgary,for the outcome of readmission to acute care hospitals


Secondary Outcome Measures:
  • Post-discharge mortality [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
    The primary outcomes of interest will be assessed through existing linkages to data from the Alberta Vital Statistics for post-discharge mortality. Such an approach to post-discharge outcome ascertainment avoids the shortcoming of unreliable patient self-report on readmission, and the potential challenges associated with determining vital status of patients that we are unable to reach by telephone.


Estimated Enrollment: 1400
Study Start Date: September 2011
Estimated Study Completion Date: September 2013
Estimated Primary Completion Date: April 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: Control group, usual care
Control group will receive usual care. This usual care typically involves paper-based handwritten discharge communications, with subsequent provision of a dictated discharge summary produced some time after hospital discharge, with unpredictable success of delivery, and with unstructured and sometimes haphazard content.
Procedure: Usual care
Control group will receive usual care. This usual care typically involves paper-based handwritten discharge communications, with subsequent provision of a dictated discharge summary produced some time after hospital discharge, with unpredictable success of delivery, and with unstructured and sometimes haphazard content.
Other Name: dictation discharge
Experimental: seamless discharge Procedure: seamless discharge
The intervention will consist of discharges being conducted with the use of the computer-enabled communication tool.For the intervention group, the care team will record the information that they collect directly into the computerized tool during the hospital stay.
Other Name: electronic discharge

Detailed Description:

The vulnerability of the transition period has been attributed to three main factors. First, changes to patients'medication regimens during hospitalization are numerous, yet failure to reconcile discrepancies between admission and discharge is frequent. Second, the patient/family is required to take over care responsibilities at discharge and must often relay important information to the primary care physician. This can be particularly challenging if discharge information is poorly communicated, presented too rapidly, if instructions are verbal only, or if the patient has low literacy or low health literacy.Finally, crucial information is often not transferred between acute care physicians and community physicians.

Information about the hospitalization (such as medication changes, patient diagnoses, interventions,diagnostic findings, and necessary follow-up) is commonly transferred to the primary care physician via a discharge summary that is typically faxed or mailed. Unfortunately, deficits with respect to timeliness and/or complete failure to transmit are widespread. At the first post-discharge appointment, the discharge summary is unavailable to the primary care physician up to 75% of the time. This negatively impacts the continuity of care provided to many patients. When summaries are received, inconsistent content and inaccuracies are common. Acute care physicians, whether medical or surgical, often neglect to include diagnostic findings, treatment/hospital course, discharge medications, pending tests results, and whether the patient and family received counselling.

Computer-enabled discharge communications have potential to avert such problems. Such communication platforms can provide an immediate link between acute care and primary care physicians, and interfaces can be designed to ensure consistent information transfer. In addition, physicians in both settings have expressed preference for electronic discharge documents over hand written/dictated summaries with respect to clarity, comprehensiveness, and positive impacts on continuity of care.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • all patients being discharged from MTU at the Foothill Medical Centre (FMC)

Exclusion Criteria:

  • all patients discharged from different wards at the FMC
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01402609

Contacts
Contact: William Ghali, MD 4032109317 wghali@ucalgary.ca
Contact: Maria Jose Santana, PhD 4032109257 mjsantan@ucalgary.ca

Locations
Canada, Alberta
The ward of 21st Century (W21C) Foothills Medical Centre Not yet recruiting
Calgary, Alberta, Canada, T2N 4Z6
Contact: William Ghali, MD    4032109317    wghali@ucalgary.ca   
Contact: Maria Jose Santana, PhD    4032109257    mjsantan@ucalgary.ca   
Sub-Investigator: Maria jose Santana, PhD         
Principal Investigator: William Ghali, MD         
Sponsors and Collaborators
Ward of the 21st Century
Canadian Institutes of Health Research (CIHR)
AHS Cancer Control Alberta
Investigators
Principal Investigator: William Ghali, MD Ward of the 21st Century
  More Information

Additional Information:
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Dr. William Ghali, MD, Ward of the 21st Century Research and Innovation Centre, University of Calgary
ClinicalTrials.gov Identifier: NCT01402609     History of Changes
Other Study ID Numbers: SeamDis2010
Study First Received: July 25, 2011
Last Updated: July 25, 2011
Health Authority: Canada: Canadian Institutes of Health Research

Keywords provided by Ward of the 21st Century:
Continuity of care
Seamless discharge

Additional relevant MeSH terms:
Pulmonary Disease, Chronic Obstructive
Lung Diseases, Obstructive
Lung Diseases
Respiratory Tract Diseases

ClinicalTrials.gov processed this record on September 11, 2014