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CAPABLE Transitions: A Home Health-Based Intervention for the Hospital or Post-Acute Care Facility-to-Home Transition

CAPABLE Transitions: A Randomized, Unblinded, 60-Subject Clinical Trial of an Occupational Therapy-Led In-Home Intervention to Help Older Adults Transition to Their Homes Following Hospital or Post-Acute Care Facility Discharge

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04460742
Enrollment
31
Registered
2020-07-08
Start date
2021-03-18
Completion date
2023-05-19
Last updated
2023-08-01

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Care Transitions, Dementia

Keywords

Post-acute care, Home health agency

Brief summary

This clinical study is designed to test the feasibility of a new intervention, CAPABLE Transitions. CAPABLE Transitions is based on the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) intervention designed by Dr. Sarah Szanton at Johns Hopkins University. Similar to CAPABLE, CAPABLE Transitions consists of an occupational therapy (OT)-led intervention in which the study OT, nurse, and handyman deliver an in-home intervention over 3-4 months. This intervention is designed to help with the transition of care from a hospital or post-acute care facility discharge as well as to optimize functioning and home safety. This clinical study plans to recruit a total of 60 older adults with and without dementia admitted to a home health agency following discharge from a hospital or post-acute care facility. Given that this is a feasibility study, it is not designed or powered to test hypotheses.

Detailed description

This pilot study is a randomized, care-as-usual (CAU)-comparator, unblinded clinical trial of an occupational therapy (OT)-led in-home intervention designed to help older adults successfully return to and remain in their homes following discharge from a hospital or post-acute care facility (e.g., skilled nursing or inpatient rehabilitation facilities). This intervention is called CAPABLE Transitions. In total, 60 adults (36 in the intervention arm, 24 in the CAU arm) aged 65 years and older recently discharged from a hospital or post-acute care facility and admitted to a Medicare-certified home health agency (CHHA) with and without dementia will be recruited. This pilot study's main outcomes relate to the feasibility of the study. These outcomes include study recruitment and retention, fidelity to and perceived benefit of the intervention, and data completeness with regard to clinical outcomes (e.g., home time, quality of life, and health care utilization). This study will recruit English-speaking adults aged 65 years and older who live in the Rochester region and are admitted to a CHHA following a hospital or post-acute care facility stay. There are two treatment groups. The intervention group will receive CAPABLE Transitions as well as CHHA CAU services. The CAU group will receive CHHA CAU services, which can include nursing, health aide, medical social work, and occupational, physical, and speech therapy services. CHHA clinicians will determine the types and duration of CHHA services that the study participants receive; these services will be completely independent from the research study. Assessment interviews will be conducted at baseline as well as at three and six month follow-up. Interviews will assess sociodemographics, health and functioning, mental health and cognitive functioning, home environment, medical services use, and intervention feedback. Information also will be extracted on medical conditions, medications, communication with providers, and services utilization from participants' medical records.

Interventions

BEHAVIORALCAPABLE Transitions

The CAPABLE Transitions intervention group will receive an occupational therapy-led multidisciplinary in-home intervention in which the study occupational therapist (\<6 visits), registered nurse (\<5 visits), and handyman (\<2 visits) work with participants over 3-4 months. This intervention group also will receive home health agency care as usual services. CAPABLE Transitions in embedded within a home health agency and includes a care transitions emphasis.

BEHAVIORALHome Health Agency Care

Both the CAPABLE Transitions intervention and care as usual treatment arms will receive home health agency care as usual services, which can include nursing, health aide, medical social work, and occupational, physical, and speech therapy services. Home health agency clinicians will determine the types and duration of CHHA services that the study participants receive; these services will be completely independent from the research study.

Sponsors

National Institute on Aging (NIA)
CollaboratorNIH
University of Rochester
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* admitted to Medicare-certified home health agency following discharge from a hospital, inpatient rehabilitation facility, or skilled nursing facility * live in Rochester, NY region * aged 65 years or older * English-speaking

Exclusion criteria

* plan to move within one year * has a terminal diagnosis (e.g., \< 1-year life expectancy, in hospice) * receiving active cancer treatment (active treatment includes surgery or a course of radiation or chemotherapy; it does not include long-term maintenance treatment such as daily hormonal treatment of prostate cancer) * inability or unwillingness of individual or legal guardian/representative to give written informed consent or assent * has been discharged from a hospital or post-acute care facility for more than 28 days * are COVID-19 positive, have suspected COVID-19 infection, or resides with a person who is COVID-19 positive or has suspected COVID-19

Design outcomes

Primary

MeasureTime frameDescription
Data Completeness on Clinical Outcomes3 monthsThe study will monitor the percentage of participants who have complete information on home time, quality of life, and health services utilization at 3 months.
Percentage of Participants Screened as EligibleFor each potential participant, this outcome is determined prior to possible study enrollment.The study will monitor how many older adults are screened and satisfy the eligibility criteria.
Percentage of Screened Participants That EnrollThis outcome is determined at the time of study enrollment.The study will monitor how many older adults who satisfy the eligibility criteria are enrolled in the study.
Percentage of Enrolled Participants That Are Retained6 monthsThe study will monitor the percentage of participants that complete the study.
Percentage of Participants Who Perceive a Benefit From the Intervention3 monthsParticipants and study partners will be asked Likert-item response survey questions to assess the perceived benefit and burdensomeness of the intervention.
Proportion of Critical Tasks CompletedThroughout Study Intervention, an average of 5 monthsThe study will review audio recordings and study interventionists' documentation to examine fidelity to the intervention and score whether the interventionists completed the central tasks of CAPABLE Transitions. The study will score completion of the critical components as yes or no and this outcome will be reported as the proportion of critical components of the CAPABLE Transitions intervention that were completed by the occupational therapist and registered nurse.

Secondary

MeasureTime frameDescription
Home Time in Days (From the 3 to 6 Month Period)Month 3 to Month 6 (3 months)Home time is the number of days participants spend alive in non-institutional settings (e.g., nursing homes and hospitals). The study will report the participants' home time from 3 to 6 months of follow-up.
Mean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)3 monthsThe study will examine quality of life (EQ-5D-5L) among study participants at 3 months of follow-up (positive scores indicate improvement from baseline). Rating: mobility, self-care, usual activities, pain/discomfort and anxiety/depression, each with 1 as lowest score and 5 as highest score: no problems, slight problems, moderate problems, severe problems and extreme problems, where higher scores indicate worse outcome. The EQ VAS question records the patient's self-rated health on a vertical visual analogue scale from 0 to 100, where the endpoints are labelled 'The best health you can imagine' (score=100) and 'The worst health you can imagine' (score=0). Therefore higher scores may indicate better outcomes.
Health Services Use, PercentageBaseline to Month 3 (3 months)The study will examine the percentage of participants who went to the emergency department, were hospitalized, and were admitted to a skilled nursing facility from baseline to 3 months of follow-up.
Health Services Use, MeanBaseline to Month 3 (3 months)The study will tabulate the mean number of times participants went to the emergency department, were hospitalized, and were admitted to a skilled nursing facility from baseline to 3 months of follow-up.
Home Time in Days (From the Baseline to 3 Month Period)Baseline to Month 3 (3 months)Home time is the number of days participants spend alive in non-institutional settings (e.g., nursing homes and hospitals). The study will report the participants' home time from baseline to 3 months of follow-up.

Countries

United States

Participant flow

Participants by arm

ArmCount
CAPABLE Transitions
Older adults admitted to University of Rochester Medicine Home Care with and without dementia will receive care as usual as well as CAPABLE-trained occupational therapy, registered nurse, and handyman services delivered over 3-4 months. CAPABLE Transitions: The CAPABLE Transitions intervention group will receive an occupational therapy-led multidisciplinary in-home intervention in which the study occupational therapist (\<6 visits), registered nurse (\<5 visits), and handyman (\<2 visits) work with participants over 3-4 months. This intervention group also will receive home health agency care as usual services. CAPABLE Transitions in embedded within a home health agency and includes a care transitions emphasis. Home Health Agency Care: Both the CAPABLE Transitions intervention and care as usual treatment arms will receive home health agency care as usual services, which can include nursing, health aide, medical social work, and occupational, physical, and speech therapy services. Home health agency clinicians will determine the types and duration of CHHA services that the study participants receive; these services will be completely independent from the research study.
16
Care As Usual
Older adults admitted to University of Rochester Medicine Home Care (a Medicare-certified home health agency) with and without dementia will receive care as usual. Home Health Agency Care: Both the CAPABLE Transitions intervention and care as usual treatment arms will receive home health agency care as usual services, which can include nursing, health aide, medical social work, and occupational, physical, and speech therapy services. Home health agency clinicians will determine the types and duration of CHHA services that the study participants receive; these services will be completely independent from the research study.
15
Total31

Baseline characteristics

CharacteristicCAPABLE TransitionsTotalCare As Usual
Age, Continuous77 Years
STANDARD_DEVIATION 6.66
74.5 Years
STANDARD_DEVIATION 6.92
71.8 Years
STANDARD_DEVIATION 6.33
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants2 Participants1 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
15 Participants29 Participants14 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Black or African American
2 Participants2 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
12 Participants27 Participants15 Participants
Region of Enrollment
United States
16 Participants31 Participants15 Participants
Sex: Female, Male
Female
13 Participants25 Participants12 Participants
Sex: Female, Male
Male
3 Participants6 Participants3 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 160 / 15
other
Total, other adverse events
3 / 161 / 15
serious
Total, serious adverse events
5 / 161 / 15

Outcome results

Primary

Data Completeness on Clinical Outcomes

The study will monitor the percentage of participants who have complete information on home time, quality of life, and health services utilization at 3 months.

Time frame: 3 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentData Completeness on Clinical Outcomes16 Participants
Care As UsualData Completeness on Clinical Outcomes14 Participants
Primary

Data Completeness on Clinical Outcomes

The study will monitor the percentage of participants who have complete information on home time, quality of life, and health services utilization at 6 months.

Time frame: 6 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentData Completeness on Clinical Outcomes14 Participants
Care As UsualData Completeness on Clinical Outcomes13 Participants
Primary

Percentage of Enrolled Participants That Are Retained

The study will monitor the percentage of participants that complete the study.

Time frame: 6 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentPercentage of Enrolled Participants That Are Retained14 Participants
Care As UsualPercentage of Enrolled Participants That Are Retained14 Participants
Primary

Percentage of Participants Screened as Eligible

The study will monitor how many older adults are screened and satisfy the eligibility criteria.

Time frame: For each potential participant, this outcome is determined prior to possible study enrollment.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentPercentage of Participants Screened as Eligible180 Participants
Primary

Percentage of Participants Who Perceive a Benefit From the Intervention

Participants and study partners will be asked Likert-item response survey questions to assess the perceived benefit and burdensomeness of the intervention.

Time frame: 6 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentPercentage of Participants Who Perceive a Benefit From the Intervention12 Participants
Primary

Percentage of Participants Who Perceive a Benefit From the Intervention

Participants and study partners will be asked Likert-item response survey questions to assess the perceived benefit and burdensomeness of the intervention.

Time frame: 3 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentPercentage of Participants Who Perceive a Benefit From the Intervention13 Participants
Primary

Percentage of Screened Participants That Enroll

The study will monitor how many older adults who satisfy the eligibility criteria are enrolled in the study.

Time frame: This outcome is determined at the time of study enrollment.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentPercentage of Screened Participants That Enroll31 Participants
Primary

Proportion of Critical Tasks Completed

The study will review audio recordings and study interventionists' documentation to examine fidelity to the intervention and score whether the interventionists completed the central tasks of CAPABLE Transitions. The study will score completion of the critical components as yes or no and this outcome will be reported as the proportion of critical components of the CAPABLE Transitions intervention that were completed by the occupational therapist and registered nurse.

Time frame: Throughout Study Intervention, an average of 5 months

ArmMeasureValue (MEAN)Dispersion
Overall Study Screening and RecruitmentProportion of Critical Tasks Completed0.89 Proportion of Critical Tasks CompletedStandard Deviation 0.08
Secondary

Health Services Use, Mean

The study will tabulate the mean number of times participants went to the emergency department, were hospitalized, and were admitted to a skilled nursing facility from 3 to 6 months of follow-up.

Time frame: Month 3 to Month 6 (3 months)

ArmMeasureGroupValue (MEAN)Dispersion
Overall Study Screening and RecruitmentHealth Services Use, MeanED Visit0.19 eventsStandard Deviation 0.4
Overall Study Screening and RecruitmentHealth Services Use, MeanHospitalization0.13 eventsStandard Deviation 0.34
Overall Study Screening and RecruitmentHealth Services Use, MeanSkilled Nursing Facility Admission0 eventsStandard Deviation 0
Care As UsualHealth Services Use, MeanED Visit0.14 eventsStandard Deviation 0.73
Care As UsualHealth Services Use, MeanHospitalization0 eventsStandard Deviation 0
Care As UsualHealth Services Use, MeanSkilled Nursing Facility Admission0 eventsStandard Deviation 0
Secondary

Health Services Use, Mean

The study will tabulate the mean number of times participants went to the emergency department, were hospitalized, and were admitted to a skilled nursing facility from baseline to 3 months of follow-up.

Time frame: Baseline to Month 3 (3 months)

ArmMeasureGroupValue (MEAN)Dispersion
Overall Study Screening and RecruitmentHealth Services Use, MeanED Visit0.06 eventsStandard Deviation 0.25
Overall Study Screening and RecruitmentHealth Services Use, MeanHospitalization0.13 eventsStandard Deviation 0.34
Overall Study Screening and RecruitmentHealth Services Use, MeanSkilled Nursing Facility Admission0 eventsStandard Deviation 0
Care As UsualHealth Services Use, MeanED Visit0.07 eventsStandard Deviation 0.26
Care As UsualHealth Services Use, MeanHospitalization0.27 eventsStandard Deviation 0.7
Care As UsualHealth Services Use, MeanSkilled Nursing Facility Admission0 eventsStandard Deviation 0
Secondary

Health Services Use, Percentage

The study will examine the percentage of participants who went to the emergency department, were hospitalized, and were admitted to a skilled nursing facility from baseline to 3 months of follow-up.

Time frame: Baseline to Month 3 (3 months)

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentHealth Services Use, PercentageSkilled Nursing Facility Admission0 Participants
Overall Study Screening and RecruitmentHealth Services Use, PercentageED Visit1 Participants
Overall Study Screening and RecruitmentHealth Services Use, PercentageHospitalization2 Participants
Care As UsualHealth Services Use, PercentageED Visit1 Participants
Care As UsualHealth Services Use, PercentageHospitalization2 Participants
Care As UsualHealth Services Use, PercentageSkilled Nursing Facility Admission0 Participants
Secondary

Health Services Use, Percentage

The study will examine the percentage of participants who went to the emergency department, were hospitalized, and were admitted to a skilled nursing facility from 3 to 6 months of follow-up.

Time frame: Month 3 to Month 6 (3 months)

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Overall Study Screening and RecruitmentHealth Services Use, PercentageED Visit3 Participants
Overall Study Screening and RecruitmentHealth Services Use, PercentageHospitalization2 Participants
Overall Study Screening and RecruitmentHealth Services Use, PercentageSkilled Nursing Facility Admission0 Participants
Care As UsualHealth Services Use, PercentageED Visit2 Participants
Care As UsualHealth Services Use, PercentageHospitalization0 Participants
Care As UsualHealth Services Use, PercentageSkilled Nursing Facility Admission0 Participants
Secondary

Home Time in Days (From the 3 to 6 Month Period)

Home time is the number of days participants spend alive in non-institutional settings (e.g., nursing homes and hospitals). The study will report the participants' home time from 3 to 6 months of follow-up.

Time frame: Month 3 to Month 6 (3 months)

ArmMeasureValue (MEAN)Dispersion
Overall Study Screening and RecruitmentHome Time in Days (From the 3 to 6 Month Period)89.38 daysStandard Deviation 2
Care As UsualHome Time in Days (From the 3 to 6 Month Period)89.86 daysStandard Deviation 0.36
Secondary

Home Time in Days (From the Baseline to 3 Month Period)

Home time is the number of days participants spend alive in non-institutional settings (e.g., nursing homes and hospitals). The study will report the participants' home time from baseline to 3 months of follow-up.

Time frame: Baseline to Month 3 (3 months)

ArmMeasureValue (MEAN)Dispersion
Overall Study Screening and RecruitmentHome Time in Days (From the Baseline to 3 Month Period)87.94 daysStandard Deviation 7.25
Care As UsualHome Time in Days (From the Baseline to 3 Month Period)88.67 daysStandard Deviation 3.99
Secondary

Mean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)

The study will examine quality of life (EQ-5D-5L) among study participants at 6 months of follow-up (positive scores indicate improvement from baseline). Rating: mobility, self-care, usual activities, pain/discomfort and anxiety/depression, each with 1 as lowest score and 5 as highest score: no problems, slight problems, moderate problems, severe problems and extreme problems, where higher scores indicate worse outcome. The EQ VAS question records the patient's self-rated health on a vertical visual analogue scale from 0 to 100, where the endpoints are labelled 'The best health you can imagine' (score=100) and 'The worst health you can imagine' (score=0). Therefore higher scores may indicate better outcomes.

Time frame: 6 months

ArmMeasureGroupValue (MEAN)Dispersion
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Mobility Change0.57 score on a scaleStandard Deviation 1.09
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Self-Care Change0.50 score on a scaleStandard Deviation 0.94
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Usual Activities Change1.21 score on a scaleStandard Deviation 1.19
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Pain/Discomfort Change0.29 score on a scaleStandard Deviation 1.07
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Anxiety/Depression Change-0.36 score on a scaleStandard Deviation 1.01
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Self-Rated Health Change8.07 score on a scaleStandard Deviation 26.83
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Anxiety/Depression Change-0.29 score on a scaleStandard Deviation 0.73
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Mobility Change0.71 score on a scaleStandard Deviation 1.07
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Pain/Discomfort Change0.50 score on a scaleStandard Deviation 1.4
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Self-Care Change0.36 score on a scaleStandard Deviation 0.93
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Self-Rated Health Change10.5 score on a scaleStandard Deviation 12.91
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Usual Activities Change0.93 score on a scaleStandard Deviation 1.07
Secondary

Mean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)

The study will examine quality of life (EQ-5D-5L) among study participants at 3 months of follow-up (positive scores indicate improvement from baseline). Rating: mobility, self-care, usual activities, pain/discomfort and anxiety/depression, each with 1 as lowest score and 5 as highest score: no problems, slight problems, moderate problems, severe problems and extreme problems, where higher scores indicate worse outcome. The EQ VAS question records the patient's self-rated health on a vertical visual analogue scale from 0 to 100, where the endpoints are labelled 'The best health you can imagine' (score=100) and 'The worst health you can imagine' (score=0). Therefore higher scores may indicate better outcomes.

Time frame: 3 months

ArmMeasureGroupValue (MEAN)Dispersion
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Mobility Change0.73 score on a scaleStandard Deviation 1.33
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Self-Care Change0.40 score on a scaleStandard Deviation 0.74
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Usual Activities Change0.73 score on a scaleStandard Deviation 1.39
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Pain/Discomfort Change-0.07 score on a scaleStandard Deviation 0.96
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Anxiety/Depression Change-0.13 score on a scaleStandard Deviation 0.64
Overall Study Screening and RecruitmentMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Self-Rated Health Change6.27 score on a scaleStandard Deviation 28.29
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Anxiety/Depression Change0.14 score on a scaleStandard Deviation 0.77
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Mobility Change1.07 score on a scaleStandard Deviation 1.07
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Pain/Discomfort Change0.36 score on a scaleStandard Deviation 1.5
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Self-Care Change0.50 score on a scaleStandard Deviation 0.76
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Self-Rated Health Change1.43 score on a scaleStandard Deviation 15.8
Care As UsualMean Change in Quality of Life Using EQ-5D-5L (Unabbreviated Title)Usual Activities Change0.79 score on a scaleStandard Deviation 1.05

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026