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Completed

NCT Number: NCT03178513

Post-Acute Physician Home Visit Program

New or worsening symptoms following discharge from the hospital likely leads to unplanned readmission. These rates are higher than desired and costly to patients, payers, and providers. Many interventions have unsuccessfully attempted to reduce readmissions, but few have provided in-home personnel to patients transitioning from acute care back to ambulatory care. Still fewer have involved a physician in the home. We therefore will test the effect of a physician home visit to a patient's home who was discharged in the last 4 days.

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Key information

Conditions

A Patient Discharged From an Acute-care Hospital Who Had an Acute Illness

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Brigham and Women's Faulkner Hospital, Boston, Massachusetts, United States

Loading trial locations.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Resides within either a 5-mile or 20-minute driving radius of Brigham and Women's Hospital (BWH) or Brigham and Women's Faulkner Hospital (BWFH) emergency room
  • Has capacity to consent to study
  • >=18 years old

Exclusion criteria

  • Undomiciled
  • In police custody
  • Domestic violence screen positive

Treatment and study plan

Home visit

Other

The visit will be entirely patient tailored, last approximately one hour, and at a minimum will entail:

  • Medical assessment
  • Psychosocial assessment
  • Medication reconciliation
  • Follow-up of inpatient primary team's specific recommendations
  • Follow-up, as needed, with primary care team or inpatient team

Primary outcomes

  1. New or worsening symptoms

    Time frame: 30 days after discharge from hospital

    "Since you got home from the hospital, have you had any symptoms at all?" If no, stop. If yes, continue.

    "I'm going to read off a list of symptoms, and I want you to tell me if that symptom is new or has gotten worse since you left the hospital. Please don't include symptoms that have stayed the same since you were in the hospital." For each affirmative, double check if the symptom is new or has gotten worse since getting out of the hospital. Only if new or worse, mark yes.

Secondary outcomes

  1. Total cost, 30-days post discharge

    Time frame: Day of discharge to 30 days later

  2. Total reimbursement, 30-days post discharge

    Time frame: Day of discharge to 30 days later

  3. 3-item Care Transition Measure, score

    Time frame: 30 days after discharge

  4. Primary care provider follow-up within 14 days, y/n

    Time frame: Day of discharge to 14 days later

  5. Ability to carry out the discharge plan, score

    Time frame: 30 days after discharge

    I would like to ask you about some more problems that you might have faced after you left the hospital one month ago. I will read some statements and ask if you agree or disagree.

  6. Change in medication list due to home visit, y/n

    Time frame: Day of home visit

    Physician-initiated medication change during home visit

  7. Receipt of prescribed medicines following discharge, y/n

    Time frame: 30 days after discharge

    Pharmacy confirmation

  8. Unplanned 30-day readmission(s) after index hospitalization, y/n

    Time frame: 30 days after discharge

  9. Unplanned 30-day readmission(s) after index hospitalization, #

    Time frame: 30 days after discharge

Other outcomes

  1. Global satisfaction with care, score

    Time frame: 30 days after discharge

    Exploratory

  2. Days at home since discharge, #

    Time frame: 30 days after discharge

    Exploratory

  3. All-cause 30-day readmission(s) after index hospitalization, y/n

    Time frame: 30 days after discharge

    Exploratory

  4. All-cause 30-day readmission(s) after index hospitalization, #

    Time frame: 30 days after discharge

    Exploratory

  5. Emergency Department (ED) observation stay(s) after index hospitalization, y/n

    Time frame: 30 days after discharge

    Exploratory

  6. Emergency Department (ED) observation stay(s) after index hospitalization, #

    Time frame: 30 days after discharge

    Exploratory

  7. Emergency Department (ED) visit(s) after index hospitalization, #

    Time frame: 30 days after discharge

    Exploratory

  8. Emergency Department (ED) visit(s) after index hospitalization, y/n

    Time frame: 30 days after discharge

    Exploratory

  9. Imaging, #

    Time frame: 30 days after discharge

    Exploratory

  10. Imaging, y/n

    Time frame: 30 days after discharge

    Exploratory

  11. Lab orders, #

    Time frame: 30 days after discharge

    Exploratory

  12. Lab orders, y/n

    Time frame: 30 days after discharge

    Exploratory

  13. Physician visits, y/n

    Time frame: 30 days after discharge

    Exploratory

  14. Physician visits, #

    Time frame: 30 days after discharge

    Exploratory

  15. Home health utilization, days

    Time frame: 30 days after discharge

    Exploratory

  16. Home health utilization, y/n

    Time frame: 30 days after discharge

    Exploratory

  17. All cause 30-day mortality, y/n

    Time frame: 30 days after discharge

    Exploratory

  18. Unplanned 30-day mortality, y/n

    Time frame: 30 days after discharge

    Exploratory

  19. Change in medication list due to error at discharge, y/n

    Time frame: Visit date

    Exploratory

  20. Pneumococcal vaccination if appropriate, y/n

    Time frame: 30 days after discharge

    Exploratory

  21. Influenza vaccination if appropriate, y/n

    Time frame: 30 days after discharge

    Exploratory

  22. Smoking cessation counseling if appropriate, y/n

    Time frame: 30 days after discharge

    Exploratory

  23. Evaluation of ejection fraction as assessed by echocardiogram or other appropriate study, scheduled or completed, if not done within 1 year; y/n

    Time frame: 30 days after discharge

    Heart failure patients only; Exploratory; appropriate studies include cardiac magnetic resonance imaging, radionuclide ventriculography, single photon emission computed tomography myocardial perfusion imaging, or left ventriculography

  24. Angiotensin converting enzyme inhibitor or angiotensin receptor blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n

    Time frame: 30 days after discharge

    Heart failure patients only; Exploratory

  25. Beta blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n

    Time frame: 30 days after discharge

    Heart failure patients only; Exploratory

  26. Aldosterone antagonist for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n

    Time frame: 30 days after discharge

    Heart failure patients only; Exploratory

  27. Lipid lowering for coronary artery disease, peripheral vascular disease, cerebrovascular accident, or diabetes, y/n

    Time frame: 30 days after discharge

    Heart failure patients only; Exploratory

  28. Smoking status post-discharge

    Time frame: 30 days after discharge

    Heart failure patients only; Exploratory

  29. Use of inappropriate medications in the elderly, y/n

    Time frame: 30 days after discharge

    Exploratory; using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Beers criteria

  30. Time between discharge and visit, days

    Time frame: Date of home visit

    Exploratory

  31. Duration of physician visit, minutes

    Time frame: Date of home visit

    Exploratory

Sponsors and collaborators

Lead sponsor

Brigham and Women's Hospital

Other

Registry information

Official study title

Post-Acute Physician Home Visits: A Randomized Controlled Trial

Important dates

Study start
2017
Primary completion
2018
Study completion
2018
First posted
Jun 7, 2017
Registry last updated
Aug 13, 2019

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.