Effect of a Quality Improvement Initiative to Address Social Determinants of Health on Rehospitalization Rates in Patients With Heart Failure

Saint Luke's Health System

Status: Enrolling

Conditions: Heart Failure

Treatments: Other: Managed Services

Study type: Interventional

Funder types: Other

Identifiers

NCT05388097

Managed Services Network

Details and patient eligibility

About

The objective of this program is to improve post-acute care coordination for necessary social services for patients leaving the hospital after recovering from an episode of decompensated heart failure.

Enrollment: 320 estimated patients

Sex: All

Ages: 18 to 99 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Aged 18-99 years
• Resident of Missouri or Kansas
• Current inpatient admission for acute heart failure

Exclusion criteria

• Under 18 years or over 99 years of age

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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320 participants in 2 patient groups

Standard Of Care - No Managed Services

No Intervention group

Description:

Subjects receive standard medical care and follow-up after hospital discharge

Managed Services After Discharge

Experimental group

Description:

Subjects receive in-home assessment and care coordination/connection with community resources after hospital discharge

Treatment:

Other: Managed Services