Discharge Follow-up Phone Calls
Conditions
Brief summary
The goal of this project is to quantify the impact of post-hospital discharge follow-up phone calls on hospital readmission, ED visits, patient satisfaction, and mortality in a general medicine inpatient population. We will obtain exploratory information on patient sub-groups at high risk for hospital readmission and on those experiencing high benefit from the follow-up phone call intervention. In addition, we will obtain data on discharge plan implementation assistance needed to support a successful transition from inpatient to outpatient care among those reached by the intervention phone call.
Detailed description
RATIONALE In the current medical literature, it is unclear how follow-up calls influence these outcomes in a general medical population. Some studies have attempted to address this question, but are limited in that they target very specific patient populations, are of insufficient quality, or evaluated follow-up calls as part of a larger care bundle. We will conduct a high quality, real-time clinical care study to determine the efficacy of a follow-up phone call program. STUDY DESIGN This is a single center, pragmatic, randomized, controlled clinical trial to investigate whether a structured post-hospital discharge follow-up phone call can improve patients' transition from in-hospital to outpatient care and improve satisfaction with their care. We will also identify the discharge implementation assistance given to those in the intervention (Phone Call) group. Outcome Measures Primary outcome for this study is readmission event rate within 30 days. Secondary outcomes include patient satisfaction which will be measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores, all cause VUMC emergency department (ED) visits, the need for assistance with discharge plan implementation, and 30 day mortality.
Interventions
BEHAVIORALFollow-up Phone Call
Patients will receive a first call attempt within 72 hours discharge.
Sponsors
Vanderbilt University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
This is a single center, pragmatic, randomized, controlled clinical trial.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* VUMC patients discharged after an inpatient status hospital stay on a general medicine service.
Exclusion criteria
* patients who experience in-hospital death * patient discharged to any post-acute care facility or inpatient hospice * left the hospital against medical advice
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With In-patient Re-admissions | 30 days | Number of participants with in-patient re-admissions |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Satisfaction: Likelihood to Recommend the Facility (Top Box Rating) | Within 60 days of Discharge | Measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores. Number of patients that reported a score of 3. Range is 0-3 with 3 being highest satisfaction. |
| Patient Satisfaction: Hospital Experience (Top Box Rating) | Within 60 days of Discharge | Measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores. Number of patients that rated the Hospital Experience as 9. Scale range is 0-9. Higher scores indicate more patient satisfaction. |
| Patient Satisfaction: Likelihood to Recommend the Facility | Within 60 days of Discharge | Measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores. Scale range is 0-3. Higher scores indicate more patient satisfaction. |
| Patient Satisfaction: Experience | Within 60 days of Discharge | Measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores. Higher scores indicate more patient satisfaction. Range is 0-9 with 9 being the most satisfied. |
| Number of Patient Received Discharge Plan Implementation Assistance | 30 days | Need for assistance in implementing discharge plan |
| Mortality | 30 days | All cause mortality |
| VUMC Emergency Department (ED) Visits | 30 days | All cause ED visits following discharge |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Phone Call Group (Intervention Arm) Follow-up Phone Call Program: Patients will receive the first call attempt within 72 hours of hospital discharge with a maximum of 3 call attempts by the study nurse made up until post-discharge day 7. The semi-structured script embedded within the program specific electronic health record Discharge Phone Call Starform is used to guide a conversation to obtain information on potential causes of hospital readmission that can be identified and addressed to improve each patient's transition to outpatient care. | 1,534 |
| Usual Care Group (Control Arm) Patients assigned to the Control Group receive standard discharge planning and follow-up per the usual care of their medical providers. | 1,520 |
| Total | 3,054 |
Baseline characteristics
| Characteristic | Usual Care Group (Control Arm) | Total | Phone Call Group (Intervention Arm) |
|---|---|---|---|
| Age, Continuous | 53.4 years STANDARD_DEVIATION 18.1 | 52.9 years STANDARD_DEVIATION 17.9 | 52.4 years STANDARD_DEVIATION 17.7 |
| Any time on Intensive Care Unit during stay | 308 Participants | 589 Participants | 281 Participants |
| Brief Health Literacy Score | 12.0 scores on a scale STANDARD_DEVIATION 3.5 | 11.91 scores on a scale STANDARD_DEVIATION 3.47 | 11.8 scores on a scale STANDARD_DEVIATION 3.5 |
| CMS Re-admission Penalty Group: Acute Myocardial Infarction | 80 Participants | 159 Participants | 79 Participants |
| CMS Re-admission Penalty Group: COPD Exacerbation | 327 Participants | 647 Participants | 320 Participants |
| CMS Re-admission Penalty Group: Coronary Artery Bypass Graph | 0 Participants | 0 Participants | 0 Participants |
| CMS Re-admission Penalty Group: Heart Failure | 234 Participants | 468 Participants | 234 Participants |
| CMS Re-admission Penalty Group: None | 825 Participants | 1661 Participants | 836 Participants |
| CMS Re-admission Penalty Group: Pneumonia | 371 Participants | 755 Participants | 384 Participants |
| CMS Re-admission Penalty Group: Stroke | 37 Participants | 59 Participants | 22 Participants |
| CMS Re-admission Penalty Group: Total hip/knee | 1 Participants | 2 Participants | 1 Participants |
| Established Primary Care Provider | 1018 Participants | 2000 Participants | 982 Participants |
| Highest Education/grade completed | 12.9 grade level in years STANDARD_DEVIATION 3.5 | 13.07 grade level in years STANDARD_DEVIATION 3.54 | 13.2 grade level in years STANDARD_DEVIATION 3.5 |
| Hospital Length of Stay | 4.6 days STANDARD_DEVIATION 4.7 | 4.54 days STANDARD_DEVIATION 4.48 | 4.5 days STANDARD_DEVIATION 4.3 |
| In-patient Admission in prior 6 months | 461 Participants | 944 Participants | 483 Participants |
| Mean number of In-Patient admissions in the prior 6 months | 0.6 in-patient admissions STANDARD_DEVIATION 1.1 | 0.6 in-patient admissions STANDARD_DEVIATION 1.184 | 0.6 in-patient admissions STANDARD_DEVIATION 1.2 |
| Predicted Re-admission risk before discharge | 23.4 percent risk STANDARD_DEVIATION 14.2 | 23.9 percent risk STANDARD_DEVIATION 15.1 | 24.4 percent risk STANDARD_DEVIATION 15.9 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 314 Participants | 637 Participants | 323 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 48 Participants | 95 Participants | 47 Participants |
| Race (NIH/OMB) White | 1158 Participants | 2322 Participants | 1164 Participants |
| Region of Enrollment United States | 1520 participants | 3054 participants | 1534 participants |
| Sex: Female, Male Female | 749 Participants | 1510 Participants | 761 Participants |
| Sex: Female, Male Male | 771 Participants | 1544 Participants | 773 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 68 / 1,534 | 75 / 1,520 |
| other Total, other adverse events | 0 / 1,534 | 0 / 1,520 |
| serious Total, serious adverse events | 0 / 1,534 | 0 / 1,520 |
Outcome results
Primary
Number of Participants With In-patient Re-admissions
Number of participants with in-patient re-admissions
Time frame: 30 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Phone Call Group (Intervention Arm) | Number of Participants With In-patient Re-admissions | 228 Participants |
| Usual Care Group (Control Arm) | Number of Participants With In-patient Re-admissions | 232 Participants |
p-value: 0.05Wilcoxon (Mann-Whitney)
Secondary
Mortality
All cause mortality
Time frame: 30 days
Population: Thirty-day mortality data was retrieved from the EHR data repository after a 120-day lag to capture delayed reporting.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Phone Call Group (Intervention Arm) | Mortality | 68 Participants |
| Usual Care Group (Control Arm) | Mortality | 75 Participants |
p-value: 0.05Chi-squared
Secondary
Number of Patient Received Discharge Plan Implementation Assistance
Need for assistance in implementing discharge plan
Time frame: 30 days
Population: Discharge plan implementation assistance was offered as part of the intervention and not to the control group.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Phone Call Group (Intervention Arm) | Number of Patient Received Discharge Plan Implementation Assistance | 463 Participants |
| Usual Care Group (Control Arm) | Number of Patient Received Discharge Plan Implementation Assistance | 0 Participants |
Secondary
Patient Satisfaction: Experience
Measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores. Higher scores indicate more patient satisfaction. Range is 0-9 with 9 being the most satisfied.
Time frame: Within 60 days of Discharge
Population: Patient experience data were retrieved from the hospital quality and patient safety office at 60 days, but assessment was administered via a survey sent to patients at their home after hospital discharge. Scores are based on the number of surveys returned
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Phone Call Group (Intervention Arm) | Patient Satisfaction: Experience | 8.2 score on a scale | Standard Deviation 1.8 |
| Usual Care Group (Control Arm) | Patient Satisfaction: Experience | 8.3 score on a scale | Standard Deviation 1.4 |
p-value: 0.05Chi-squared
p-value: 0.05Wilcoxon (Mann-Whitney)
Secondary
Patient Satisfaction: Hospital Experience (Top Box Rating)
Measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores. Number of patients that rated the Hospital Experience as 9. Scale range is 0-9. Higher scores indicate more patient satisfaction.
Time frame: Within 60 days of Discharge
Population: Patient experience data were retrieved from the hospital quality and patient safety office at 60 days, but assessment was administered via a survey sent to patients at their home after hospital discharge. Scores are based on the number of surveys returned
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Phone Call Group (Intervention Arm) | Patient Satisfaction: Hospital Experience (Top Box Rating) | 155 Participants |
| Usual Care Group (Control Arm) | Patient Satisfaction: Hospital Experience (Top Box Rating) | 173 Participants |
p-value: 0.05Chi-squared
Secondary
Patient Satisfaction: Likelihood to Recommend the Facility
Measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores. Scale range is 0-3. Higher scores indicate more patient satisfaction.
Time frame: Within 60 days of Discharge
Population: Patient experience data were retrieved from the hospital quality and patient safety office at 60 days, but assessment was administered via a survey sent to patients at their home after hospital discharge. Scores are based on the number of surveys returned
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Phone Call Group (Intervention Arm) | Patient Satisfaction: Likelihood to Recommend the Facility | 2.7 score on a scale | Standard Deviation 0.7 |
| Usual Care Group (Control Arm) | Patient Satisfaction: Likelihood to Recommend the Facility | 2.7 score on a scale | Standard Deviation 0.6 |
p-value: 0.05Wilcoxon (Mann-Whitney)
Secondary
Patient Satisfaction: Likelihood to Recommend the Facility (Top Box Rating)
Measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores. Number of patients that reported a score of 3. Range is 0-3 with 3 being highest satisfaction.
Time frame: Within 60 days of Discharge
Population: Patient experience data were retrieved from the hospital quality and patient safety office at 60 days, but assessment was administered via a survey sent to patients at their home after hospital discharge. Scores are based on the number of surveys returned.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Phone Call Group (Intervention Arm) | Patient Satisfaction: Likelihood to Recommend the Facility (Top Box Rating) | 168 Participants |
| Usual Care Group (Control Arm) | Patient Satisfaction: Likelihood to Recommend the Facility (Top Box Rating) | 193 Participants |
p-value: 0.05Chi-squared
p-value: 0.05Chi-squared
Secondary
VUMC Emergency Department (ED) Visits
All cause ED visits following discharge
Time frame: 30 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Phone Call Group (Intervention Arm) | VUMC Emergency Department (ED) Visits | 93 ED visits |
| Usual Care Group (Control Arm) | VUMC Emergency Department (ED) Visits | 82 ED visits |
p-value: 0.05Chi-squared