Patient Discharge
Conditions
Brief summary
The purpose of this study is to improve discharge planning effectiveness by comparing two strategies \[on-Demand Discharge Planning (DDP) vs. Routine Discharge Planning (RDP)\], in terms of reduction of hospital readmissions for inpatients classified at intermediate risk of complex discharge using the simplified Blaylock Risk Assessment Screening Score (BRASS).
Detailed description
The purpose of this study is to improve discharge planning effectiveness by comparing two strategies \[on-Demand Discharge Planning (DDP) vs. Routine Discharge Planning (RDP)\], in terms of reduction of hospital readmissions for inpatients classified at intermediate risk of complex discharge using the simplified Blaylock Risk Assessment Screening Score (BRASS). Five Internal Medicine Unit and four Units of Neurology will be randomized to the two different strategies of discharge planning (RDP or DDP), based on two different alternating sequences of four periods (each period comprising three months). The randomization will be stratified by type of unit. Patients at risk of complex discharge, according to the simplified BRASS score, are assigned to the Hospital Unit of Continuity of Care (NOCC) team, using the hospital telematics system. Afterwards, the NOCC team proposes an appropriate discharge planning, considering clinical and social needs.
Interventions
OTHEROn Demand Discharge Planning (DDP)
Patients with an intermediate score, according to the simplified Blaylock Risk Assessment Screening Score, are addressed to the NOCC team (hospital Continuity of care team) only in case of a specific request by the unit of hospitalization.
OTHERRoutine Discharge Planning (RDP)
All patients with an intermediate threshold value of the simplified Blaylock Risk Assessment Screening Score are submitted to discharge planning by the NOCC team (Hospital Unit of Continuity of Care)
Sponsors
A.O.U. Città della Salute e della Scienza
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
NONE
Intervention model description
cluster randomized cross-over trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults patients (age ≥ 18 years); * Residents in Piedmont, Italy; * Patients admitted to General Internal Medicine or Neurology Units of Molinette Hospital (Turin) * Patients with a score in the simplified BRASS between 4 and 6 at admission No specific
Exclusion criteria
were applied.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Unexpected hospital readmission within 90 days from discharge | 90 days | Proportion of hospital admissions in the standard admission regime within 90 days from the date of discharge. The endpoint will be calculated only for patients discharged alive. Readmissions for any cause under ordinary admissions will be considered as event. The Day Hospital re-admissions will not be considered for the endpoint calculation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Long Length of Stay (LLOS) | 150 days | Proportion of admissions with long duration of hospitalization (LLOS - Long Length of Stay). The endpoint will be calculated for all hospitalized patients. An admission will be considered as LLOS if its duration will be higher than the 90th specific percentile for Diagnostic Related Group (DRG ) detected at the regional level in Piedmont in 2016. |
| Death within 90 days from discharge | 90 days | Proportion of deaths within 90 days of discharge date. The endpoint will be calculated only for patients discharged alive. Death for any cause will be considered as event. |
| Proportion of patients reported to the NOCC team during the DDP-experimental phase | 150 days | Incidence of activations of the NOCC in the periods of adoption of the DDP strategy (only for admissions treated with DDP strategy) |
| Healthcare costs until 90 days from the discharge | 90 days | Health care costs charged to the National Health Service (NHS) between the date of admission and 90 days from the date of discharge or death of the patient. |
Countries
Italy
Outcome results
None listed