An Emergency Department-To-Home Intervention to Improve Quality of Life and Reduce Hospital Use

University of Florida

Status: Completed

Conditions: ED Patients With Chronic Medical Illnesses

Treatments: Other: Usual Care; Behavioral: ED-to-home care transition intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT02079987

PCORI-1306-01451 (Other Grant/Funding Number)

IRB201400005

Details and patient eligibility

About

The purpose of this study is to determine if assigning older, chronically ill patients a healthcare coach after they leave the Emergency Department (ED) improves their quality of life and reduces the need for hospital-based care.

Full description

Investigators will review the ED electronic medical record in real-time to determine ED patients' study eligibility. Older, chronically ill ED patients who are eligible and agree to participate in the study will be randomly assigned to a healthcare coach and Care Transition Intervention or usual, post-ED care.

At the time of enrollment, all subjects will be asked to provide informed consent for study investigators to request Medicare Claims to determine how many ED visits, hospital admissions and doctor office visits the subject had at least 30 days after the index ED visit. All research participants will be asked basic personal information such as age, race, sex, employment and marital status. All subjects will be asked to complete a baseline survey about their quality of life.

If the subject is assigned to the Care Transition Intervention, the healthcare coach will visit the subject at home within 3 days of the ED visit. The coach will talk with the subject about following up with a regular, personal doctor and symptoms that indicate a worsening health condition. The coach will help the subject understand their medicines and help the subject make a personal health record (PHR). The coach will tell the subject about the Area Agency on Aging. If the subject receives usual care, they but will be given the usual discharge instructions from the ED nurse and doctor. If the subject receives the Care Transition Intervention, the coach will also call the subject at least 3 times after the ED visit and review the same items listed above.

All enrolled subjects will be asked to complete a phone survey within 31-60 days of the ED visit. This survey will again ask subjects about their quality of life.

Enrollment: 1,101 patients

Sex: All

Ages: 60+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 60 years of age or older
• Medicare beneficiaries
• Community dwelling
• Reside within defined geographical area (to enable home visits)
• Have a working telephone
• Have at least one of the following conditions documented in their electronic medical record: congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, diabetes, stroke, pneumonia, medical and surgical back conditions (predominantly spinal stenosis), hip fracture, peripheral vascular disease, cardiac arrhythmias, deep venous thrombosis, pulmonary embolism, peptic ulcer disease or hemorrhage

Exclusion criteria

• Current diagnosis of psychosis
• Cancer
• Dialysis
• History of organ transplantation
• Dementia without a live-in caregiver, or
• In hospice care
• Reside outside the defined geographical area
• Reside in a skilled nursing or assisted living facility

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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1,101 participants in 2 patient groups

ED-to-home care transition intervention

Experimental group

Description:

The ED-to-home care transition intervention is a coaching intervention. It is a 4-week program that uses an Area Agency on Aging healthcare coach to conduct a home visit and at least 3 follow-up phone calls to help patients develop the skills needed for self-management and to communicate with healthcare providers.

Treatment:

Behavioral: ED-to-home care transition intervention

Usual Care

Experimental group

Description:

Patients randomized to usual care will receive verbal and written discharge instructions from the treating ED physician and nurse as is the standard of care.

Treatment:

Other: Usual Care