Testing the Re-Engineered Hospital Discharge

This study has been completed.
Sponsor:
Information provided by:
Boston University
ClinicalTrials.gov Identifier:
NCT00252057
First received: November 10, 2005
Last updated: April 13, 2009
Last verified: April 2009

November 10, 2005
April 13, 2009
December 2005
October 2007   (final data collection date for primary outcome measure)
Total Number of Rehospitalizations (Emergency Department Visits Plus Hospital Admissions) in the 30 Days After Discharge. [ Time Frame: 30 days after discharge ] [ Designated as safety issue: Yes ]
rehospitaliazation rates at 1 month post discharge
Complete list of historical versions of study NCT00252057 on ClinicalTrials.gov Archive Site
Adverse Events One Month After Discharge [ Time Frame: 30 days after discharge ] [ Designated as safety issue: Yes ]
adverse events at 1 month post discharge
Not Provided
Not Provided
 
Testing the Re-Engineered Hospital Discharge
Testing the Re-Engineered Hospital Discharge

The purpose of this study is to determine if the "Re-Engineered Discharge" will decrease rehospitalization rates and adverse events of patients leaving Boston Medical Center.

This project responds to the problems of non-standardized care and discontinuity at hospital discharge. Post-discharge adverse events are common and have been well documented. However, to date, there are no studies demonstrating the effectiveness of any procedures or tools designed to reduce them. This work builds on our "Safe Practices Implementation Challenge Grant" in which we developed the "Reengineered Hospital Discharge" tool, a set of 10 discrete, mutually reinforcing components. Hypotheses: The newly designed "Re-engineered Hospital Discharge" intervention will (1) reduce the percentage of patients experiencing a post-discharge adverse event, and (2) reduce subsequent hospital utilization (emergency department visits and rehospitalization) within 30 days following hospital discharge. Population Studied: Patients from a network of Community Health Centers discharged from a general medical service at an urban hospital. The subjects studied represent a low-income, ethnically diverse urban population. This study meets AHRQ guidelines for the inclusion of priority populations in research. Methods: 432 adult patients admitted to the general medical service of Boston Medical Center will be enrolled and randomized to (1) those receiving routine discharge as defined by our "Process Map" (Control Group); and (2) those receiving our "Re-engineered Hospital Discharge" intervention, a set of 10 discrete, mutually reinforcing components provided by a Discharge Advocate and re-enforced by a telephone call 2-4 days after discharge by a clinical pharmacist (Intervention Group). Outcome Measures: The primary patient centered outcomes are: the combined 30-day subsequent hospital utilization (readmission and emergency department use), and health status as measured by the SF-12. Process outcomes include the number and severity of the adverse events related to the discharge 30 days after discharge. Although not a primary outcome, an economic analysis will be completed. Expected Results: This project will provide valuable information about whether the "Re-Engineered Discharge" will reduce adverse events related to discharge and decrease subsequent hospital utilization. Deliverables/Dissemination: An advisory committee of senior Boston Medical Center leaders will oversee the project and, if proven effective, will implement the intervention throughout our Academic Medical Center. The "Re-engineered Hospital Discharge" tool will be widely generalizable and widely disseminated.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Prevention
ALL
Behavioral: Re-Engineered Discharge
The "Re-engineered Hospital Discharge" (Project RED) intervention provides a set of 11 discrete, mutually reinforcing components provided by a Discharge Advocate and re-enforced by a telephone call after discharge by a clinical pharmacist.
Other Name: RED
  • Experimental: Re-engineered hospital discharge
    Participants received the "Re-Engineered Hospital Discharge", a set of 11 discrete, mutually reinforcing components provided by a Discharge Advocate and re-enforced by a telephone call 2-4 days after discharge by a clinical pharmacist.
    Intervention: Behavioral: Re-Engineered Discharge
  • No Intervention: Standard hospital discharge
    Participants received the routine, standard hospital discharge.
Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O'Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009 Feb 3;150(3):178-87.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
749
October 2007
October 2007   (final data collection date for primary outcome measure)

Inclusion Criteria:

The Project Director will meet with the subject to determine if the patient meets inclusion or exclusion criteria.

Inclusion criteria include are patients who:

  1. are over 18 years old;
  2. are to be discharged to a community, non-institutionalized setting;
  3. report that they desire to be hospitalized in the future if there is a clinical need; and
  4. are admitted to Firm B of the BMC Inpatient Service.

Exclusion Criteria:

  1. admitted to non-general Medical services at BMC (e.g., orthopedic surgery, obstetrics and gynecology, otolaryngology, general surgery, or psychiatry);
  2. requiring hospice, nursing home or other institutional settings upon discharge,
  3. who die during the admission,
  4. subjects who speak languages other than English;
  5. those who indicate that they have no access to a telephone or unable to give a contact telephone number; and
  6. those not competent to sign informed consent.
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00252057
IU18HS015905-01, RFA-HS-05-012
No
Ellen Jamieson, Boston Medical Center
Boston University
Not Provided
Principal Investigator: Brian Jack, MD Boston Medical Center - Family Medicine
Boston University
April 2009

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP