Reducing Hospital Readmissions in Patients With Depressive Symptoms (RED-D)

Boston Medical Center (BMC)

Status: Completed

Conditions: Depression

Treatments: Other: RED-D Care Management

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT01840826

H-31632

1R01HS019700 (U.S. AHRQ Grant/Contract)

Details and patient eligibility

About

Project Re-Engineered Discharge (Project RED) has previously demonstrated that patients who received the RED were 30% less likely than patients receiving usual care to access inpatient or emergency services within 30 days of discharge. In this project, the investigators add a new dimension to RED by integrating screening, referral and treatment for depression into the original RED intervention and determining if this enhanced intervention increases the effectiveness of RED in preventing readmissions and controlling costs in the 180 days after discharge for patients with signs of depression.

Enrollment: 709 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Over 18 years of age
• Admitted to any Boston Medical Center inpatient service or for observation
• Screen positive for depressive symptoms (Patient Health Questionnaire - 2 >/= 3)
• Speaks English with health care providers
• Has access to a telephone
• Live in the Boston area and don't plan on leaving the Boston area for more than 2 weeks in the next 6 months
• Screen positive for depressive symptoms (PHQ -9 >/= 10)

Exclusion criteria

• Has plans for inpatient rehabilitation, nursing home, or other institutional settings after discharge.
• Suicidal precautions
• Sickle Cell Crisis (SCC)
• Alcohol and/or drug dependence
• Diagnosis of Bipolar Disorder, Schizophrenia or other Psychotic Disorder
• In police custody

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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709 participants in 2 patient groups

RED-D Care Management

Experimental group

Description:

Patients randomized to receive the Intervention work with a RED-D Care Manager post-discharge. The Care Manager meets with the patient in the hospital, prior to discharge, and post-discharge via weekly phone calls. Patients have access to a range of treatment options, overseen by the Care Manager, including: (1) medication; (2) cognitive behavioral therapy (CBT); (3) complementary and alternative medicine (CAM) information and referral; (4) Self-help, such as reading a book, making a change in diet and/or exercise in order to improve mood; (5) active surveillance; and (6) any combination of 1, 2, 3, 4 \& 5.

Treatment:

Other: RED-D Care Management

RED and Behavioral Health Referral

No Intervention group

Description:

Patients randomized to the "control" group will receive the regular RED intervention, including a follow-up phone call two days post-discharge from the hospital to review and confirm medications, and a referral to behavioral health.