Patient-centered Care Transitions in Heart Failure: A Pragmatic Cluster Randomized Trial (PACT-HF)

Population Health Research Institute (PHRI)

Status: Completed

Conditions: Heart Failure

Treatments: Other: PACT-HF Model

Study type: Interventional

Funder types: Other

Identifiers

NCT02112227

PACT-HF

Details and patient eligibility

About

Heart failure (HF) is the most common cause of hospitalization in older adults. The month after hospital discharge represents a vulnerable period, when patients are at increased risk of death and readmission to hospital. Research has shown that certain discharge-planning services can reduce death and readmissions, but these have not been widely implemented. In this study, we will group evidence-informed discharge-planning services into 'Patient-centered Care Transitions in HF' (PACT-HF), a model of care that will prepare patients for their transition from hospital to home. Through PACT-HF, patients will benefit from a comprehensive assessment of their health care needs, learn to recognize and manage symptoms of HF, and receive the information and follow-up care needed to optimize their health. We will introduce PACT-HF to 10 Ontario hospitals over a number of time periods using a stepped wedge cluster trial design. We will compare the outcomes (hierarchically ordered) of patients in hospitals with PACT-HF to those in hospitals without PACT-HF. We anticipate that patients hospitalized at the sites with PACT-HF will have fewer readmissions, emergency visits, and deaths after discharge; report a better quality of life; and feel more prepared for discharge. We also anticipate that overall, PACT-HF will reduce health system costs.

Enrollment: 3,500 patients

Sex: All

Ages: 16+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• In participating hospitals, all patients hospitalized with the most responsible diagnosis of Heart Failure

Exclusion criteria

• Patients who die during hospitalization or are transferred to another hospital

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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3,500 participants in 2 patient groups

Discharge planning services

Active Comparator group

Description:

Proven effective discharge-planning services will be grouped into 'patient-centered care transitions in heart failure' patients. This will be known as the PACT-HF model.

Treatment:

Other: PACT-HF Model

Standard Care

No Intervention group

Description:

Standard of care will be provided to HF patients at discharge.