All
Conditions
Keywords
rehospitalization, readmission, adverse events, discharge
Brief summary
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.
Detailed description
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.
Interventions
BEHAVIORALRe-Engineered Hospital 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.
Sponsors
Boston University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Number of Rehospitalizations (Emergency Department Visits Plus Hospital Admissions) in the 30 Days After Discharge. | 30 days after discharge | The total number of rehospitalizations (emergency department visits plus hospital admissions) in the 30 days after discharge, compared across study arms. Participants could have more than one rehospitalization in this period; all rehospitalizations for each were counted, making the unit of measure the rehospitalizations and not the participants. |
Countries
United States
Participant flow
Recruitment details
All participants were recruited between January 1, 2006 and October 16, 2007, from the general medical floors at Boston Medical Center.
Pre-assignment details
The baseline interview was conducted after enrollment and prior to group assignment, but it did not affect this assignment or lead to exclusion from the study for any participant. All participants who gave consent and agreed to be in the study were assigned to a group
Participants by arm
| Arm | Count |
|---|---|
| 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. | 373 |
| Standard Hospital Discharge Participants received the routine, standard hospital discharge. | 376 |
| Total | 749 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 1 | 2 |
| Overall Study | Participant previously enrolled | 0 | 1 |
| Overall Study | Withdrawal by Subject | 2 | 5 |
Baseline characteristics
| Characteristic | Standard Hospital Discharge | Re-engineered Hospital Discharge | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 62 Participants | 61 Participants | 123 Participants |
| Age, Categorical Between 18 and 65 years | 314 Participants | 312 Participants | 626 Participants |
| Age, Continuous | 49.6 years STANDARD_DEVIATION 15.3 | 50.1 years STANDARD_DEVIATION 15.1 | 49.9 years STANDARD_DEVIATION 15.2 |
| Region of Enrollment United States | 376 participants | 373 participants | 749 participants |
| Sex: Female, Male Female | 199 Participants | 178 Participants | 377 Participants |
| Sex: Female, Male Male | 177 Participants | 195 Participants | 372 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 373 | 0 / 376 |
| serious Total, serious adverse events | 0 / 373 | 0 / 376 |
Outcome results
Primary
Total Number of Rehospitalizations (Emergency Department Visits Plus Hospital Admissions) in the 30 Days After Discharge.
The total number of rehospitalizations (emergency department visits plus hospital admissions) in the 30 days after discharge, compared across study arms. Participants could have more than one rehospitalization in this period; all rehospitalizations for each were counted, making the unit of measure the rehospitalizations and not the participants.
Time frame: 30 days after discharge
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Re-engineered Hospital Discharge | Total Number of Rehospitalizations (Emergency Department Visits Plus Hospital Admissions) in the 30 Days After Discharge. | 116 Total number of rehospitalizations |
| Standard Hospital Discharge | Total Number of Rehospitalizations (Emergency Department Visits Plus Hospital Admissions) in the 30 Days After Discharge. | 166 Total number of rehospitalizations |