Emergency Department (ED) Disability Diagnostic Tool - Full Text View

Purpose

Aim 1: To develop and validate an Emergency Department(ED) Rasch Disability Diagnostic Tool (RDDT).

Hypothesis:

Rasch modeling will provide an instrument with better measurement properties, including increased reliability and validity compared to currently available ED measure of disability (MOD).

Aim 2: To conduct a randomized controlled trial to evaluate the utility of the ED-RDDT to reduce rehospitalizations in Medicare recipients visiting an urban Emergency Department for non-traumatic illness

Hypotheses:

Compared to the standard screening tool, the ED RDDT will reduce reutilization of the hospital (ED visits, hospital admissions, or death) within 60 days of discharge.
The ED RDDT will reduce costs to Medicare, hospitals and patients.

Condition	Intervention
Disability Diagnosis	Other: RDDT

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Diagnostic
Official Title:	ED Disability Diagnostic Tool: a Health Information Technology Feasibility Study

Resource links provided by NLM:

MedlinePlus related topics: Medicare

U.S. FDA Resources

Further study details as provided by Yale University:

Primary Outcome Measures:

the presence/absence of at least one visit to the ED, hospital admission or death within 90 days of the initial ED visit. [ Time Frame: 90 days ] [ Designated as safety issue: No ]

Estimated Enrollment:	600
Study Start Date:	August 2011
Estimated Study Completion Date:	May 2015
Estimated Primary Completion Date:	May 2015 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
No Intervention: MOD Group evaluated using the currently available ED measure of disability (MOD)
Experimental: RDDT Group will be evaluated using ED Rasch Disability Diagnostic Tool (RDDT)	Other: RDDT

Detailed Description:

Research Overview - The overarching aim of this study is to improve health outcomes for patients presenting to EDs by modifying and testing a disability diagnostic tool. The investigators expect a more accurate and precise tool will lead to better discharge plans and referrals for ED patients, reduce morbidity and mortality, and reduce unnecessary hospital visits and costs. The investigators will develop the core set of indicators with face (logical) validity from our research team of disability, emergency medicine, and geriatric medicine experts and practitioners. These experts will choose which pieces of information need to be included and group the selected pieces of information into content areas. Each content area will contain pieces of information that measure the same unidimensional concept. The investigators go through a series of Rasch analyses to establish which sets of information are in fact unidimensional and form usable scales. The investigators will test the validity of this preliminary version of the RDDT on existing hospital data by using it to predict health outcomes. Finally the investigators will consult the panel of experts to determine which information items, if any, are essential and missing from each content area. If there are such items they will be added to the RDDT. As described in the Preliminary Studies section, previous measures of disability were used for persons in long term care (LTC) and thus, need to be validated for use in the ED. The retrospective analysis will determine which indicators have superior measurement properties for use in the ED, plus, the retrospective analyses will link ED patient disability to health outcomes a necessary external validation step. A modified RDDT will be used in the prospective phase of the study. As lengthy diagnostic tools are neither feasible nor practical in the ED, Rasch scales are more useful in that subsets scale well and retain their measurement properties that remain accurate and precise. The investigators will conduct a randomized clinical trial (prospective phase) allocating patients into the study arm utilizing the RDDT (new tool) to compare with the control arm (standard care using MOD) to determine which measure is more accurate and precise as a measure of disability. There are both retrospective and prospective aspects to this multi-methodological interdisciplinary study.

Eligibility

Ages Eligible for Study:	65 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients who present to the adult ED at the Yale New Haven Hospital (YNHH)
65 years or older
Medicare recipients
Community dwellers.

Exclusion Criteria:

Patients and their guardians will be excluded for the following reasons:
1. Non English speaking
2. suffering from a condition that precludes interview i.e. communication impairment
3. unable to provide two contact numbers for follow-up
4. presenting with acute psychosis or are suicidal.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01416857

Contacts

Contact: Christal M Esposito	203-737-3313	christal.esposito@yale.edu
Contact: Lori A Post, PhD	203-785-4363	lori.post@yale.edu

Locations

United States, Connecticut
Yale University, Emergency Department	Recruiting
New Haven, Connecticut, United States, 06519
Contact: Christal M Esposito 203-737-3313 Christal.esposito@yale.edu
Yale New Haven Emergency Department	Recruiting
New Haven, Connecticut, United States, 06519
Contact: Christal M Esposito 203-737-3313 Christa.esposito@yale.edu

Sponsors and Collaborators

Yale University

Agency for Healthcare Research and Quality (AHRQ)

Investigators

Principal Investigator:

Lori A Post, PhD

Yale University School of Medicine, Emergency Medicine

More Information

Publications:

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Clancy CM. Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction. Am J Med Qual. 2009 Jul-Aug;24(4):344-6. Epub 2009 Jun 5. No abstract available.

Epstein AM. Revisiting readmissions--changing the incentives for shared accountability. N Engl J Med. 2009 Apr 2;360(14):1457-9. No abstract available.

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McCaig LF, Nawar EW. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data. 2006 Jun 23;(372):1-29.

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Hahn EA, Cella D. Health outcomes assessment in vulnerable populations: measurement challenges and recommendations. Arch Phys Med Rehabil. 2003 Apr;84(4 Suppl 2):S35-42. Review.

Stiell A, Forster AJ, Stiell IG, van Walraven C. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ. 2003 Nov 11;169(10):1023-8.

Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. J Am Geriatr Soc. 2004 Sep;52(9):1417-23.

Hustey FM, Mion LC, Connor JT, Emerman CL, Campbell J, Palmer RM. A brief risk stratification tool to predict functional decline in older adults discharged from emergency departments. J Am Geriatr Soc. 2007 Aug;55(8):1269-74.

Miller T. Increasing longevity and Medicare expenditures. Demography. 2001 May;38(2):215-26.

Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003 Apr;51(4):451-8.

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009 Apr 2;360(14):1418-28. Erratum in: N Engl J Med. 2011 Apr 21;364(16):1582.

Caplan GA, Brown A, Croker WD, Doolan J. Risk of admission within 4 weeks of discharge of elderly patients from the emergency department--the DEED study. Discharge of elderly from emergency department. Age Ageing. 1998 Nov;27(6):697-702.

Currie CT, Lawson PM, Robertson CE, Jones A. Elderly patients discharged from an accident and emergency department--their dependency and support. Arch Emerg Med. 1984 Dec;1(4):205-13.

McCusker J, Verdon J, Tousignant P, de Courval LP, Dendukuri N, Belzile E. Rapid emergency department intervention for older people reduces risk of functional decline: results of a multicenter randomized trial. J Am Geriatr Soc. 2001 Oct;49(10):1272-81.

Responsible Party:	Lori Post, Associate Professor, Yale University
ClinicalTrials.gov Identifier:	NCT01416857 History of Changes
Other Study ID Numbers:	1004006652, 1R01 HS0184120-01A1
Study First Received:	August 11, 2011
Last Updated:	February 5, 2013
Health Authority:	United States: Federal Government United States: Institutional Review Board

Keywords provided by Yale University:

Medicare

ClinicalTrials.gov processed this record on May 16, 2013