A Technology Assisted Care Transition Intervention for Veterans With CHF or COPD
| Status: | Recruiting |
|---|---|
| Conditions: | Chronic Obstructive Pulmonary Disease |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/27/2019 |
| Start Date: | May 1, 2018 |
| End Date: | September 30, 2020 |
| Contact: | Timothy P Hogan, PhD MS BS |
| Email: | timothy.hogan@va.gov |
| Phone: | (781) 687-3181 |
A Technology-Assisted Care Transition Intervention for Veterans With Chronic Heart Failure or Chronic Obstructive Pulmonary Disease
Transition from hospital to home places patients in jeopardy of adverse events and increases
their risk for rehospitalization. CHF is the most prevalent chronic condition among U.S.
adults and COPD is the third leading cause of death in the U.S. Both CHF and COPD represent
significant burdens for the VHA healthcare system. Care transitions can be supported through
multi-component interventions, but are costly to implement. Virtual nurses provide an
effective medium for explaining health concepts to patients, and previous work indicates
patients find virtual nurses acceptable. The investigators will implement and evaluate a
virtual nurse intervention to provide automated, tailored, and timely support to Veterans
transitioning from hospital to home. As effective care transition interventions incorporate
both inpatient and outpatient components, the virtual nurse will first engage with patient
onscreen during their inpatient stay and then via text message post-discharge. This project
has the potential to improve the care transition experience for patients, caregivers and
healthcare providers.
their risk for rehospitalization. CHF is the most prevalent chronic condition among U.S.
adults and COPD is the third leading cause of death in the U.S. Both CHF and COPD represent
significant burdens for the VHA healthcare system. Care transitions can be supported through
multi-component interventions, but are costly to implement. Virtual nurses provide an
effective medium for explaining health concepts to patients, and previous work indicates
patients find virtual nurses acceptable. The investigators will implement and evaluate a
virtual nurse intervention to provide automated, tailored, and timely support to Veterans
transitioning from hospital to home. As effective care transition interventions incorporate
both inpatient and outpatient components, the virtual nurse will first engage with patient
onscreen during their inpatient stay and then via text message post-discharge. This project
has the potential to improve the care transition experience for patients, caregivers and
healthcare providers.
The last decade has seen a steady increase in the resources that VHA uses to treat chronic
heart failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD), both of which are among
the most common reasons for admission and re-admission in VHA facilities. Multi-component
care transition interventions can be effective, but are costly. One approach to reduce
complexity and costs is to offload some work to technology.
Informed by the sociotechnical model, this study proposes a technology-assisted care
transition intervention founded on the concept of a virtual nurse that interacts with
Veterans through different technology channels. The virtual nurse is an anthropomorphized
computer program designed to simulate a discharge nurse. During the inpatient stay, the
virtual nurse will appear on a computer touch screen and will educate Veterans with CHF or
COPD about the important components of a care transition (drawing on the Coleman Care
Transition Model) as well as how to send and receive text messages on their mobile phone.
Following discharge to home, the virtual nurse will continue to coach Veterans and their
family members and improve post-discharge access to care through two-way computer-tailored
text messaging made possible by VHA's new HealtheDialog system. Specific aims are to:
1. Refine methods and collect formative measures to guide implementation
2. Conduct a randomized trial of the technology-assisted care transition intervention
3. Evaluate the intervention, including its effectiveness, implementation, and budget
impact
The investigators propose a mixed methods formative assessment and simulation experiment to
refine existing technologies to the VA care transition setting (Aim 1). This will be followed
by a multi-site randomized type1 hybrid implementation trial (Aims 2 and 3). The trial will
evaluate the effectiveness of the virtual nurse intervention in twelve clinical teams and
also gather information about its implementation to inform broader rollout.
heart failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD), both of which are among
the most common reasons for admission and re-admission in VHA facilities. Multi-component
care transition interventions can be effective, but are costly. One approach to reduce
complexity and costs is to offload some work to technology.
Informed by the sociotechnical model, this study proposes a technology-assisted care
transition intervention founded on the concept of a virtual nurse that interacts with
Veterans through different technology channels. The virtual nurse is an anthropomorphized
computer program designed to simulate a discharge nurse. During the inpatient stay, the
virtual nurse will appear on a computer touch screen and will educate Veterans with CHF or
COPD about the important components of a care transition (drawing on the Coleman Care
Transition Model) as well as how to send and receive text messages on their mobile phone.
Following discharge to home, the virtual nurse will continue to coach Veterans and their
family members and improve post-discharge access to care through two-way computer-tailored
text messaging made possible by VHA's new HealtheDialog system. Specific aims are to:
1. Refine methods and collect formative measures to guide implementation
2. Conduct a randomized trial of the technology-assisted care transition intervention
3. Evaluate the intervention, including its effectiveness, implementation, and budget
impact
The investigators propose a mixed methods formative assessment and simulation experiment to
refine existing technologies to the VA care transition setting (Aim 1). This will be followed
by a multi-site randomized type1 hybrid implementation trial (Aims 2 and 3). The trial will
evaluate the effectiveness of the virtual nurse intervention in twelve clinical teams and
also gather information about its implementation to inform broader rollout.
Inclusion Criteria:
- Veterans
- Diagnosis of chronic heart failure or chronic obstructive pulmonary disease
- Admission to a general medical service
- Able and willing to engage with touchscreen technology
- Have a text-enabled cellular phone to receive the post-discharge text messages
Exclusion Criteria:
- Not Veterans
- Not diagnosed of chronic heart failure or chronic obstructive pulmonary disease
- Not admitted to a general medical service
- Not capable of using touchscreen technology
- Do not have a text-enabled cellular phone
We found this trial at
5
sites
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Bedford, Massachusetts 01730
Principal Investigator: Timothy Patrick Hogan, PhD MS BS
Phone: (781) 687-3417
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Boston, Massachusetts 02130
Phone: 857-364-5704
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