Cardiac Condition
Conditions
Brief summary
The study had three parts: Part 1: Patients (or their home caretakers) who live outside of Denver and receive their primary care at a location other than the Denver VAMC were interviewed after their discharge. The interview covered the patient's perspective about the transition of their medical care from the Denver VA to their primary care facility. Part 2: Primary care providers from the VA facilities that refer patients to the Denver VA were interviewed regarding their opinions of transition process from the Denver VA back to the primary care VA facilities. Part 3: The data from the above interviews were used to develop an intervention to improve the transition process from the Denver VA back to the primary care VA facilities.
Detailed description
Aim 1 was to describe barriers and facilitators of the transition process from hospital to home through qualitative interviews among patients discharged from Denver VA Medical Center (tertiary facility) after being transferred from a primary care VA. Aim 2 was to describe barriers and facilitators of the transition process through qualitative interviews among providers at primary care VA facilities who take care of patients discharged from the Denver VA Medical Center for a cardiac condition. Aim 3 was to pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1) PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical attention. This pilot was informed by the interviews from Aims 1 and 2 and best practices from the literature. Finally, as part of Aim 3, the primary care providers who saw the patients who completed the pilot were contacted to ask for their input and feedback regarding the pilot project. Description of Enrolled Population: Study Design and Research Methods This was a mixed methods study where both qualitative and quantitative methods were employed. Through a series of qualitative interviews (n=26), potential barriers and facilitators of the current discharge process were assessed in this hub and spoke model of cardiac care. Informed by these interviews, the transitions of care intervention refined elements from prior studies that have improved this transition process. Finally, a pilot test of this intervention was implemented to assess the effectiveness of the intervention to improve important processes of care during this transition period among patients (n=8) discharged from Denver VAMC after transfer from a primary care VA facility.
Interventions
BEHAVIORALIntervention
Informed by the interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1) PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical attention
Sponsors
US Department of Veterans Affairs
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
Yes
Inclusion criteria
Aims 1 and 3: * Patients transferred from primary care VA facilities (i.e., Cheyenne, Grand Junction, Sheridan, Ft. Harrison) for cardiac care (e.g., heart failure, acute myocardial infarction) or procedures (coronary angiography, pacemaker implantation) to the Denver VAMC and discharged home to follow-up with their primary care provider, were eligible. Aim 2: * Providers from VA primary care facilities, (i.e., Cheyenne, Grand Junction, Sheridan, and Ft. Harrison) who took care of patients discharged from the Denver VAMC for cardiology care, were eligible for the qualitative interviews.
Exclusion criteria
Aims 1 and 3: *
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| See Primary Outcome Description Below | Within 2 weeks of discharge | Follow up appointment within 2 weeks of discharge back to their primary care providers at a primary care facility from a tertiary referral center. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Arm 1 Eight patients who were being discharged from Denver VA Medical Center for cardiac care to their primary care providers were recruited at the time of discharge and completed an interview two weeks following their discharge. Patients were asked to describe their transition to home and identify barriers and facilitators of this process, their understanding of their medical condition, new medications prescribed, timeliness of follow-up visit with their PCP and knowledge of signs/symptoms in which they should seek medical attention. | 8 |
| Arm 2 Three providers who refer patients to the Denver VA Medical Center for cardiac care were interviewed to identify barriers and facilitators from their perspective of following-up with patients after their hospitalization at Denver VAMC. Additionally, the same information was asked of providers who participated in two focus groups in the Grand Junction VA. | 3 |
| Arm 3 Informed by the interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1)PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical attention
Intervention: Informed by the interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1) PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical att | 8 |
| Total | 19 |
Baseline characteristics
| Characteristic | Arm 1 | Arm 2 | Arm 3 | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 participants | 0 participants | 0 participants | 0 participants |
| Age, Categorical >=65 years | 8 participants | NA participants | 8 participants | NA participants |
| Age, Categorical Between 18 and 65 years | 0 participants | NA participants | 0 participants | NA participants |
| Region of Enrollment United States | 8 participants | 3 participants | 8 participants | 19 participants |
| Sex: Female, Male Female | 4 Participants | NA Participants | 4 Participants | NA Participants |
| Sex: Female, Male Male | 4 Participants | NA Participants | 4 Participants | NA Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 8 | 0 / 3 | 0 / 8 |
| serious Total, serious adverse events | 0 / 8 | 0 / 3 | 0 / 8 |
Outcome results
Primary
See Primary Outcome Description Below
Follow up appointment within 2 weeks of discharge back to their primary care providers at a primary care facility from a tertiary referral center.
Time frame: Within 2 weeks of discharge
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1 | See Primary Outcome Description Below | Medication reconciliation | 4 participants |
| Arm 1 | See Primary Outcome Description Below | Subjects Interviewed | 8 participants |
| Arm 1 | See Primary Outcome Description Below | Discharge Instructions | 8 participants |
| Arm 1 | See Primary Outcome Description Below | Follow-up within 2 weeks of discharge | 3 participants |
| Arm 2 | See Primary Outcome Description Below | Medication reconciliation | NA participants |
| Arm 2 | See Primary Outcome Description Below | Follow-up within 2 weeks of discharge | NA participants |
| Arm 2 | See Primary Outcome Description Below | Subjects Interviewed | 3 participants |
| Arm 2 | See Primary Outcome Description Below | Discharge Instructions | NA participants |
| Arm 3 | See Primary Outcome Description Below | Discharge Instructions | 8 participants |
| Arm 3 | See Primary Outcome Description Below | Subjects Interviewed | 8 participants |
| Arm 3 | See Primary Outcome Description Below | Follow-up within 2 weeks of discharge | 6 participants |
| Arm 3 | See Primary Outcome Description Below | Medication reconciliation | 8 participants |