Discharge Follow-up Phone Call Program (FUTR-30)

Vanderbilt University Medical Center

Status: Completed

Conditions: Discharge Follow-up Phone Calls

Treatments: Behavioral: Follow-up Phone Call

Study type: Interventional

Funder types: Other

Identifiers

NCT03050918

170019

Details and patient eligibility

About

The goal of this project is to quantify the impact of post-hospital discharge follow-up phone calls on hospital readmission, ED visits, patient satisfaction, and mortality in a general medicine inpatient population. We will obtain exploratory information on patient sub-groups at high risk for hospital readmission and on those experiencing high benefit from the follow-up phone call intervention. In addition, we will obtain data on discharge plan implementation assistance needed to support a successful transition from inpatient to outpatient care among those reached by the intervention phone call.

Full description

RATIONALE

In the current medical literature, it is unclear how follow-up calls influence these outcomes in a general medical population. Some studies have attempted to address this question, but are limited in that they target very specific patient populations, are of insufficient quality, or evaluated follow-up calls as part of a larger care bundle. We will conduct a high quality, real-time clinical care study to determine the efficacy of a follow-up phone call program.

STUDY DESIGN

This is a single center, pragmatic, randomized, controlled clinical trial to investigate whether a structured post-hospital discharge follow-up phone call can improve patients' transition from in-hospital to outpatient care and improve satisfaction with their care. We will also identify the discharge implementation assistance given to those in the intervention (Phone Call) group.

Outcome Measures Primary outcome for this study is readmission event rate within 30 days. Secondary outcomes include patient satisfaction which will be measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores, all cause VUMC emergency department (ED) visits, the need for assistance with discharge plan implementation, and 30 day mortality.

Enrollment: 3,054 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• VUMC patients discharged after an inpatient status hospital stay on a general medicine service.

Exclusion criteria

• patients who experience in-hospital death
• patient discharged to any post-acute care facility or inpatient hospice
• left the hospital against medical advice

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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3,054 participants in 2 patient groups

Phone Call Group (Intervention Arm)

Active Comparator group

Description:

Follow-up phone call intervention: Patients will receive the first call attempt within 72 hours of hospital discharge with a maximum of 3 call attempts by the study nurse made up until post-discharge day 7. The semi-structured script embedded within the program specific electronic health record Discharge Phone Call Starform is used to guide a conversation to obtain information on potential causes of hospital readmission that can be identified and addressed to improve each patient's transition to outpatient care.

Treatment:

Behavioral: Follow-up Phone Call

Usual Care Group (Control Arm)

No Intervention group

Description:

Patients assigned to the control group receive standard discharge planning and follow-up per the usual care of their medical providers.