A Patient Discharged From an Acute-care Hospital Who Had an Acute Illness
Conditions
Brief summary
New or worsening symptoms following discharge from the hospital likely leads to unplanned readmission. These rates are higher than desired and costly to patients, payers, and providers. Many interventions have unsuccessfully attempted to reduce readmissions, but few have provided in-home personnel to patients transitioning from acute care back to ambulatory care. Still fewer have involved a physician in the home. We therefore will test the effect of a physician home visit to a patient's home who was discharged in the last 4 days.
Interventions
OTHERHome visit
The visit will be entirely patient tailored, last approximately one hour, and at a minimum will entail: * Medical assessment * Psychosocial assessment * Medication reconciliation * Follow-up of inpatient primary team's specific recommendations * Follow-up, as needed, with primary care team or inpatient team
Sponsors
Brigham and Women's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Resides within either a 5-mile or 20-minute driving radius of Brigham and Women's Hospital (BWH) or Brigham and Women's Faulkner Hospital (BWFH) emergency room * Has capacity to consent to study * \>=18 years old
Exclusion criteria
* Undomiciled * In police custody * Domestic violence screen positive
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| New or worsening symptoms | 30 days after discharge from hospital | Since you got home from the hospital, have you had any symptoms at all? If no, stop. If yes, continue. I'm going to read off a list of symptoms, and I want you to tell me if that symptom is new or has gotten worse since you left the hospital. Please don't include symptoms that have stayed the same since you were in the hospital. For each affirmative, double check if the symptom is new or has gotten worse since getting out of the hospital. Only if new or worse, mark yes. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total reimbursement, 30-days post discharge | Day of discharge to 30 days later | — |
| 3-item Care Transition Measure, score | 30 days after discharge | — |
| Primary care provider follow-up within 14 days, y/n | Day of discharge to 14 days later | — |
| Ability to carry out the discharge plan, score | 30 days after discharge | I would like to ask you about some more problems that you might have faced after you left the hospital one month ago. I will read some statements and ask if you agree or disagree. |
| Total cost, 30-days post discharge | Day of discharge to 30 days later | — |
| Receipt of prescribed medicines following discharge, y/n | 30 days after discharge | Pharmacy confirmation |
| Unplanned 30-day readmission(s) after index hospitalization, y/n | 30 days after discharge | — |
| Unplanned 30-day readmission(s) after index hospitalization, # | 30 days after discharge | — |
| Change in medication list due to home visit, y/n | Day of home visit | Physician-initiated medication change during home visit |
Other
| Measure | Time frame | Description |
|---|---|---|
| Lab orders, # | 30 days after discharge | Exploratory |
| Lab orders, y/n | 30 days after discharge | Exploratory |
| Physician visits, y/n | 30 days after discharge | Exploratory |
| Physician visits, # | 30 days after discharge | Exploratory |
| Home health utilization, days | 30 days after discharge | Exploratory |
| Home health utilization, y/n | 30 days after discharge | Exploratory |
| All cause 30-day mortality, y/n | 30 days after discharge | Exploratory |
| Unplanned 30-day mortality, y/n | 30 days after discharge | Exploratory |
| Change in medication list due to error at discharge, y/n | Visit date | Exploratory |
| Pneumococcal vaccination if appropriate, y/n | 30 days after discharge | Exploratory |
| Influenza vaccination if appropriate, y/n | 30 days after discharge | Exploratory |
| Smoking cessation counseling if appropriate, y/n | 30 days after discharge | Exploratory |
| Evaluation of ejection fraction as assessed by echocardiogram or other appropriate study, scheduled or completed, if not done within 1 year; y/n | 30 days after discharge | Heart failure patients only; Exploratory; appropriate studies include cardiac magnetic resonance imaging, radionuclide ventriculography, single photon emission computed tomography myocardial perfusion imaging, or left ventriculography |
| Angiotensin converting enzyme inhibitor or angiotensin receptor blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n | 30 days after discharge | Heart failure patients only; Exploratory |
| Beta blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n | 30 days after discharge | Heart failure patients only; Exploratory |
| Global satisfaction with care, score | 30 days after discharge | Exploratory |
| Lipid lowering for coronary artery disease, peripheral vascular disease, cerebrovascular accident, or diabetes, y/n | 30 days after discharge | Heart failure patients only; Exploratory |
| Smoking status post-discharge | 30 days after discharge | Heart failure patients only; Exploratory |
| Use of inappropriate medications in the elderly, y/n | 30 days after discharge | Exploratory; using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Beers criteria |
| Time between discharge and visit, days | Date of home visit | Exploratory |
| Duration of physician visit, minutes | Date of home visit | Exploratory |
| Aldosterone antagonist for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n | 30 days after discharge | Heart failure patients only; Exploratory |
| Days at home since discharge, # | 30 days after discharge | Exploratory |
| All-cause 30-day readmission(s) after index hospitalization, y/n | 30 days after discharge | Exploratory |
| All-cause 30-day readmission(s) after index hospitalization, # | 30 days after discharge | Exploratory |
| Emergency Department (ED) observation stay(s) after index hospitalization, y/n | 30 days after discharge | Exploratory |
| Emergency Department (ED) observation stay(s) after index hospitalization, # | 30 days after discharge | Exploratory |
| Emergency Department (ED) visit(s) after index hospitalization, # | 30 days after discharge | Exploratory |
| Emergency Department (ED) visit(s) after index hospitalization, y/n | 30 days after discharge | Exploratory |
| Imaging, # | 30 days after discharge | Exploratory |
| Imaging, y/n | 30 days after discharge | Exploratory |
Countries
United States
Outcome results
None listed