Comparative Effectiveness of Readmission Reduction Interventions for Individuals with Sepsis or Pneumonia (ACCOMPLISH)

University of Pittsburgh

Status: Completed

Conditions: Lower Resp Tract Infection; Covid19; Pneumonia; Sepsis

Treatments: Behavioral: Standard Response Team; Behavioral: High-intensity Remote Patient Monitoring (RPM-High); Behavioral: Low-intensity Remote Patient Monitoring (RPM-Low); Behavioral: Enhanced Response Team; Behavioral: Structured Telephone Support (STS)

Study type: Interventional

Funder types: Other

Identifiers

NCT04829188

STUDY20080130

Details and patient eligibility

About

An adaptive platform trial to compare effectiveness of different care models to prevent readmissions for patients hospitalized with sepsis or lower respiratory tract infection. The primary outcome is number of days spent at home within 90 days after hospital discharge.

Full description

This study implements an adaptive platform trial to compare effectiveness of different care models to prevent readmissions for patients hospitalized with sepsis or lower respiratory tract infection and discharged to home (with or without a short stay in a skilled nursing facility prior to going home): structured telephone support (STS); low-intensity remote patient monitoring (RPM-Low); and high-intensity remote patient monitoring (RPM-High). The remote patient monitoring models will be staffed by a physician or a nurse (Standard Team) or by a dedicated nurse-practitioner (NP)-led multidisciplinary team (Enhanced Team). Patients will be randomized to one of five arms: STS, RPM-Low + Standard Team, RPM-Low + Enhanced Team, RPM-High + Standard Team, and RPM-High + Enhanced Team. Using response adaptive randomization (RAR), interim outcome results will be used to modify the random allocation of patients to each study arm. The primary outcome is number of days spent at home within 90 days after hospital discharge. Patient-reported functional status and quality of life data will be collected in addition to electronic health record (EHR) and claims-based data to measure health care utilization. Qualitative interviews with patients and providers will provide insight into the effectiveness of the implementation process.

Enrollment: 1,288 patients

Sex: All

Ages: 21+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• UPMC Health Plan members
• Medicare Fee-for-Service enrollees
• Age 21+ -Hospitalized with a primary diagnosis of sepsis or lower respiratory tract infection, --
• Discharged to home, independent living facility, or skilled nursing facility
• Readmission risk is moderate or high

Exclusion criteria

• Admitted from hospice;
• Discharged to hospice, inpatient rehabilitation, or a long term acute care facility;
• Known to be pregnant;
• Current enrollment in another remote patient monitoring program;
• Failure of the Callahan 6 item cognitive screen and do not have a proxy to consent;
• No access to a technological device required to participate in remote patient monitoring program;
• Current enrollment in UPMC Advanced Illness Care program;
• Severe, persistent cognitive impairment;
• No documented PCP;
• PCP disapproves of the patient being enrolled in remote patient monitoring;
• Discharged from hospital to skilled nursing facility and stay at the skilled nursing facility for greater than 28 days

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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1,288 participants in 5 patient groups

Structured Telephone Support (STS)

Active Comparator group

Description:

Post-discharge assessment, education, and medication reconciliation delivered telephonically by a health plan case manager, home care as needed, and follow-up with the primary care provider (PCP) within seven days post-discharge.

Treatment:

Behavioral: Structured Telephone Support (STS)

Low-intensity Remote Patient Monitoring (RPM) + Standard Response Team (RPM-Low, Standard Team)

Active Comparator group

Description:

Questions are pushed to members patients times per week for up to 90 days post-discharge. Questions are limited to those checking vital signs that indicate worsening of infection. Patient answers to RPM questions trigger High or Medium alerts, which trigger a response by members of the intervention care team. RPM alerts are screened by a nurse-staffed call center. Nurses determine whether emergency care is needed. If not, nurses contact the patient and/or the patients' primary care provider (PCP) or specialist to coordinate care and ensure timely follow-up.

Treatment:

Behavioral: Low-intensity Remote Patient Monitoring (RPM-Low)

Behavioral: Standard Response Team

High-intensity Remote Patient Monitoring (RPM) plus the Standard Team (RPM-High, Standard Team)

Active Comparator group

Description:

Questions are pushed to patients multiple times per week for up to 90 days post-discharge. Questions include monitoring vital signs for worsening infection but also ask about factors that would indicate worsening of underlying heart or lung conditions, such as weight gain or shortness of breath. Patient answers to RPM questions trigger High or Medium alerts, which trigger a response by members of the intervention care team. RPM alerts are screened by a nurse-staffed call center. Nurses determine whether emergency care is needed. If not, nurses contact the patient and/or the patients' primary care provider (PCP) or specialist to coordinate care and ensure timely follow-up.

Treatment:

Behavioral: High-intensity Remote Patient Monitoring (RPM-High)

Behavioral: Standard Response Team

Low-intensity Remote Patient Monitoring (RPM) + Enhanced Team (RPM-Low, Enhanced Team)

Active Comparator group

Description:

Questions are pushed to patients multiple times per week for up to 90 days post-discharge. Questions are limited to those checking vital signs that indicate worsening of infection. Patient answers to RPM questions trigger High or Medium alerts, which trigger a response by members of the intervention care team. RPM alerts are screened by a nurse-staffed call center. Nurses determine whether emergency care is needed. If not, the call center alerts a multidisciplinary care team that is led by a certified registered nurse practitioner (CRNP). CRNPs, who operate in a palliative care role, have prescribing authority and can modify care plans. In addition to reacting to RPM triggers, team members (e.g., CRNP, social workers, nurses) meet with the patient in-person or virtually in the week after discharge and at least twice more in the next 90 days, conduct assessments and a pharmacy review, develop care plans, and discuss advance directives).

Treatment:

Behavioral: Enhanced Response Team

Behavioral: Low-intensity Remote Patient Monitoring (RPM-Low)

High-intensity Remote Patient Monitoring (RPM) plus the Enhanced Team (RPM-High, Enhanced Team)

Active Comparator group

Description:

Questions are pushed to patients multiple times per week for up to 90 days post-discharge. Questions include monitoring vital signs for worsening infection but also ask about factors that would indicate worsening of underlying heart or lung conditions, such as weight gain or shortness of breath. Patient answers to RPM questions trigger High or Medium alerts, which trigger a response by members of the intervention care team. RPM alerts are screened by a nurse-staffed call center. Nurses determine whether emergency care is needed. If not, the call center alerts a multidisciplinary care team that is led by a certified registered nurse practitioner (CRNP). CRNPs, who operate in a palliative care role, have prescribing authority and can modify care plans.Team members (e.g., CRNP, social workers, nurses) address RPM triggers, meet with the patient three times, pharmacy review, develop care plans, and discuss advance directives).

Treatment:

Behavioral: Enhanced Response Team

Behavioral: High-intensity Remote Patient Monitoring (RPM-High)