The Care Transitions Intervention

Tracking Information
First Submitted Date ICMJE	October 24, 2005
First Posted Date ICMJE	October 26, 2005
Last Update Posted Date	August 13, 2015
Study Start Date ICMJE	September 2002
Primary Completion Date	Not Provided
Current Primary Outcome Measures ICMJE; (submitted: October 24, 2005)	Rehospitalization rate at 30, 90 and 180 days after index hospitalization.
Original Primary Outcome Measures ICMJE	Same as current
Change History	Complete list of historical versions of study NCT00244491 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures ICMJE; (submitted: October 24, 2005)	Rehospitalization rate at 30, 90 and 180 days after index hospitalization. Rehospitalization for the same condition as the index hospital stay, at 30, 90 and 180 days.
Original Secondary Outcome Measures ICMJE	Same as current
Current Other Outcome Measures ICMJE	Not Provided
Original Other Outcome Measures ICMJE	Not Provided
Descriptive Information
Brief Title ICMJE	The Care Transitions Intervention
Official Title ICMJE	The Care Transitions Intervention
Brief Summary	This intervention tests whether encouraging older patients and their caregivers to assert a more active role in their care transitions could improve clinical outcomes. Patients are supported by a nurse transition coach and specific tools, including a Personal Health Record.
Detailed Description	See above.
Study Type ICMJE	Interventional
Study Phase	Not Applicable
Study Design ICMJE	Allocation: Randomized; Intervention Model: Single Group Assignment; Masking: None (Open Label)
Condition ICMJE	Continuity of Patient Care
Intervention ICMJE	Behavioral: Care Transitions Intervention
Study Arms	Not Provided
Publications *	Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006 Sep 25;166(17):1822-8.
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status ICMJE	Completed
Enrollment ICMJE; (submitted: May 17, 2006)	1400
Original Enrollment ICMJE; (submitted: October 24, 2005)	750
Study Completion Date	August 2003
Primary Completion Date	Not Provided
Eligibility Criteria ICMJE	Inclusion Criteria: To be eligible for this study, patients from the participating delivery system had to: 1) be age 65 years or older, 2) be admitted to one of the participating delivery system's contract hospitals during the study period for a non-psychiatrically-related condition, 3) be community-dwelling (i.e., not from a long-term care facility), 4) reside within a predefined geographic radius of the hospital (thereby making a home visit feasible), 5) have a working telephone, 6) be English-speaking, 7) show no documentation of dementia in the medical record, 8) have no plans to enter hospice, 9) not be participating in another research protocol, and 10) have documented in their medical record at least one of 11 diagnoses, including stroke, congestive heart failure, coronary artery disease, cardiac arrhythmias, chronic obstructive pulmonary disease, diabetes, spinal stenosis, hip fracture, peripheral vascular disease, deep venous thrombosis, or pulmonary embolism. Exclusion Criteria: Those who did not meet the inclusion criteria.
Sex/Gender	Sexes Eligible for Study: All
Ages	65 Years and older (Adult, Senior)
Accepts Healthy Volunteers	No
Contacts ICMJE	Contact information is only displayed when the study is recruiting subjects
Listed Location Countries ICMJE	United States
Removed Location Countries
Administrative Information
NCT Number ICMJE	NCT00244491
Other Study ID Numbers ICMJE	00-1036
Has Data Monitoring Committee	Not Provided
U.S. FDA-regulated Product	Not Provided
IPD Sharing Statement	Not Provided
Responsible Party	University of Colorado, Denver
Study Sponsor ICMJE	University of Colorado, Denver
Collaborators ICMJE	The John A. Hartford Foundation
Investigators ICMJE	Principal Investigator: Eric A. Coleman, MD, MPH University of Colorado, Denver
PRS Account	University of Colorado, Denver
Verification Date	August 2015
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP