AKI - Acute Kidney Injury, Cellulitis, Congestive Heart Failure, Diabetic Foot Infection, Osteomyelitis, Pneumonia, Pyelonephritis, Syncope
Conditions
Keywords
Patient safety, Cost effectiveness, Avoidable hospitalizations
Brief summary
The Next Day Clinic (NDC) is a quality improvement initiative that will be launched and operated by UCLA Health starting July 22, 2024. Its goals are to improve patient care and safety and to maximize cost effectiveness. The way it does this is by identifying patients in the ED who would normally be admitted for low-acuity conditions, and diverting them to a high-acuity clinic the following day called the NDC. This will help decompress the ED and the hospital, and allow for overall higher quality care. The Health System has partnered with UCLA's Healthcare Value Analytics and Solutions \[UVAS\] group which specializes in these types of program evaluations. The analysis conducted by the study team will be used to directly inform NDC operations, scaling, and future plans.
Detailed description
NDC is a hospital avoidance model with the potential to simultaneously improve the quality and safety of acute care, reduce costs, and address hospital/ED overcrowding. This novel hospital avoidance program will divert patients from the ED who have been diagnosed with the following conditions and meet certain clinical criteria: * Diabetic Foot Infection/Osteomyelitis * Cellulitis * Congestive Heart Failure * Syncope * Pyelonephritis/Urinary Tract Infection * Pneumonia * Acute Kidney Infection
Interventions
OTHERNext Day Clinic
A dedicated Next Day Clinic team consisting of a clinician and nurse case manager will provide care and specialist referrals to patients within 24 hours of an ED visit that would have resulted in hospitalization without this novel hospital avoidance initiative.
Sponsors
University of California, Los Angeles
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Randomized encouragement trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years of age or older * About to be admitted through the ED for one of the NDC diagnoses or a synonym (per Study Protocol document), defined by the presence of a Plan to Admit order or Bed Request order, OR recently admitted under observation or inpatient status for one of the NDC diagnoses. * Identified as at-risk for an avoidable hospitalization in the ED based on a pre-determined set of lab and vital parameters. * Insurance that authorizes the patient to follow-up at UCLA Health, or self-pay * Admitted or being admitted to an internal medicine service
Exclusion criteria
* Heart or lung transplant recipient with concern for graft dysfunction * Pregnant * Enrolled in hospice * Admitted to a critical care service * ED deems discharge unsafe due to complex social or medical factors * Active malignant cancer (per Council of State and Territorial Epidemiologists value set) * Pulmonary arterial hypertension (per Joint Commission value set) * Undergoing workup for solid organ transplant * Interstitial lung disease (including pulmonary fibrosis) (per Higher Level 7 value set) * Requiring inpatient procedure or surgery defined by the presence of an anesthesia event or operating room encounter. * The ED deems discharge unsafe due to complex social or medical factors. * Transferred to an ineligible hospital Note: The Health System plans to limit the volume of referrals to the NDC by only referring patients who have an even birth date (this is more equitable than first-come-first-serve, because wage workers are more likely to come to the ED later in the day; even/odd birth date theoretically keeps more spots open for patients presenting to the ED later).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Days alive and out of hospital (DAOH) | 30 days from index ED visit | Cumulative number of days alive and not admitted or boarding in a hospital or emergency department |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Global health-related quality of life | 30 days from index ED visit | Composite PROMIS-29+2 score (patient reported outcome measurement information system). PROMIS stands for Patient-Reported Outcomes Measurement Information System. High scores mean more of the concept being measured. |
| Patient experience | 30 days from index ED visit | Measured by PSQ-18 (patient satisfaction questionnaire). PSQ stands for Patient Satisfaction Questionnaire. High scores indicate higher levels of satisfaction. |
| Financial analysis | Through study completion, an average of 12 months | Total cost per day of treatment |
| Cost effectiveness analysis | Through study completion, an average of 12 months | Total cost per day alive and out of hospital |
| Hospitalizations avoided | Through study completion, an average of 12 months | Each NDC referral with a preceding Plan to Admit order or Bed Request order (regardless of treatment arm) will be considered an avoided hospitalization, given that the presence of one of these orders establishes that the counterfactual for NDC treatment in hospitalization. |
| Hospital bed-days saved | Through study completion, an average of 12 months | For each referral to the NDC, the number of hospital bed-days saved will be established by using the mean length of stay for patients treated per-protocol in the control condition matched for the same presenting illness. |
Countries
United States
Outcome results
None listed