Support From Hospital to Home for Elders: A Randomized Controlled Study
Status: | Completed |
---|---|
Conditions: | Hospital |
Therapuetic Areas: | Other |
Healthy: | No |
Age Range: | 55 - Any |
Updated: | 5/27/2013 |
Start Date: | July 2010 |
End Date: | June 2013 |
Contact: | Eric R Kessell, PhD |
Email: | ekessell@medsfgh.ucsf.edu |
Phone: | 415-206-4921 |
The investigators will randomize 700 non-psychiatric, non-obstetric, non-surgical patients
aged 55 years and older at San Francisco General Hospital (SFGH) to usual care (ten days of
prescription medication, discharge summary sent to primary care provider (PCP), and
outpatient appt made for patient, and patient's nurse reviews discharge plan,) or usual care
plus a peridischarge intervention (a visit with specialized in-hospital discharge nurse,
development of personalized discharge plan, two phone calls from a nurse
practitioner(NP)/physician assistant (PA) after discharge and availability of additional
calls back from NP/PA, upon patient request, to help answer questions and assist patient's
transition to outpatient care, and communication with primary care/subspecialty providers).
The usual care and usual care plus intervention groups will be assessed for differences in
mortality and rates of rehospitalization and emergency department use 30, 90 and 180 days
following discharge from the hospital.
The discharge process from the hospital to home is frequently marked by poor quality and
high risk of adverse events and readmissions. It has been hypothesized that better
coordinated care, personalized patient education, and follow-up calls to identify potential
sources of adverse events, such as medical complications and medication errors can reduce
rehospitalization and emergency room visits following discharge from the hospital. Although
these interventions have been shown to reduce combined hospital readmissions and emergency
department visits in English-speaking patients, none has focused on elderly patients in a
diverse urban public hospital setting that includes non-English-speakers, who might benefit
more than other populations from enhanced services during and after discharge from the
hospital. Further, these labor-intensive interventions are costly to implement, and it is
unknown whether opportunity cost of providing additional services in a limited-resource
environment such as San Francisco General Hospital (SFGH) outweighs the unknown clinical
benefits.
Inclusion Criteria:
- patients age 55 and older
- admitted to the general medicine, family medicine, cardiology, and neurology services
at San Francisco General Hospital,
- able to communicate in either English, Spanish, Mandarin or Cantonese,
- attending physicians agree to the patient's participation.
- Patients must be able to demonstrate an understanding of the study's goals through a
set of teach back questions included in the consent process.
Exclusion Criteria:
- transferred from an outside hospital;
- admitted for a planned hospitalization (e.g. chemotherapy, a planned surgery)
- requiring hospice, nursing home, rehab or other institutional settings (i.e. expected
by the physician team to be discharged to skilled nursing facilities) - those unable
to independently consent (i.e. severely cognitively impaired, delirious, deaf, or
involuntarily hospitalized because of severe mental illness)
- unable to understand English, Spanish or Cantonese (as reported by medical teams or
unable to complete the consent teach-back process)
- less than age 55
- aphasic
- otherwise excluded by the medical team
- participated in the pilot project of this intervention.
We found this trial at
1
site
San Francisco General Hospital San Francisco General Hospital and Trauma Center (SFGH) is an essential...
Click here to add this to my saved trials
