Geriatric Syndrome
Conditions
Keywords
comprehensive geriatrics assessment, telehealth, home visit
Brief summary
The overall objective of the TeleGRACE project is to improve the care and outcomes of older Veterans with a recent inpatient stay by expanding access to the evidence-based GRACE program, by evaluating a telehealth implementation.
Detailed description
The TeleGRACE evaluation will focus on three primary aims and a secondary aim: Primary Aim 1: To examine the effectiveness of the TeleGRACE program, the investigators designed a randomized controlled implementation trial (RCT) powered for the primary outcome of 90-day all-cause mortality. The investigators will also examine its effectiveness for the secondary outcomes including 90-day readmissions, 1-year ED utilization (VA and non-VA), 1-year all-cause readmissions, 1-year mortality, as well as patient, caregiver, and staff satisfaction. The investigators hypothesize that patients who receive TeleGRACE will have lower 90-day mortality than patients in usual care. Primary Aim 2: to examine the implementation of the TeleGRACE program. The implementation strategy is reflecting & evaluating. Implementation outcomes are based on the REAIM framework and include reach, efficacy (Aim 1), and implementation (total number of Veterans served, fidelity). Primary Aim 3: to conduct a business-case analysis (BCA). The business case analysis will calculate the net financial savings or loss for TeleGRACE as the difference in the overall intervention costs and savings due to downstream benefits for patients receiving TeleGRACE versus usual care controls.
Interventions
OTHERTeleGRACE
Patients receive a virtual home visit and care from the GRACE team
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Veterans discharged from the Indianapolis VA medical center (VAMC) for an medical/surgical diagnosis (excludes substance use disorder-related admissions; excludes planned admissions) within the prior week * Age 70 years * Not enrolled in home-based primary care (HBPC) * Not enrolled in hospice * Not in dialysis * Primary care visit within VA in the prior 2 years * Not residing in nursing home, skilled nursing facility, or CLC. * Living \>20 miles but \<60 miles from the Indianapolis VAMC facility * CAN score 95th percentile for mortality or missing CAN score * Discharged from the hospital alive
Exclusion criteria
* Patients who have been randomized to the control arm after their index hospitalization who become readmitted to the hospital may not be re-randomized. * By definition, GRACE patients are not eligible for TeleGRACE due to the drive distance \>20 miles from the Indianapolis VAMC * Enrolled in home-based primary care (HBPC) * Enrolled in hospice * Dialysis (hemodialysis or peritoneal dialysis) * Residing in nursing home, skilled nursing facility, or CLC. * Living \<20 miles or 60 miles from the Indianapolis VAMC facility
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 90-day All-cause Mortality | 90-days from discharge from the index hospitalization | The primary outcome is 90-day all-cause mortality measured from the date of discharge from the index hospitalization. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| TeleGRACE Patients receive a virtual home visit and care from the GRACE team
TeleGRACE: Patients receive a virtual home visit and care from the GRACE team | 73 |
| Usual Care Patients receive usual care | 38 |
| Total | 111 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 68 | 0 |
Baseline characteristics
| Characteristic | Usual Care | Total | TeleGRACE |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 38 Participants | 111 Participants | 73 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 77.0 years STANDARD_DEVIATION 5.7 | 77.4 years STANDARD_DEVIATION 5.9 | 77.7 years STANDARD_DEVIATION 6.1 |
| Race and Ethnicity Not Collected | — | 0 Participants | — |
| Region of Enrollment United States | 38 participants | 111 participants | 73 participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 38 Participants | 111 Participants | 73 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 5 | 0 / 38 |
| other Total, other adverse events | 0 / 5 | 0 / 38 |
| serious Total, serious adverse events | 0 / 5 | 0 / 38 |
Outcome results
Primary
90-day All-cause Mortality
The primary outcome is 90-day all-cause mortality measured from the date of discharge from the index hospitalization.
Time frame: 90-days from discharge from the index hospitalization
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| TeleGRACE | 90-day All-cause Mortality | 0 Participants |
| Usual Care | 90-day All-cause Mortality | 0 Participants |