The Care Transitions Intervention

Continuity of Patient Care Clinical Trial

Official title:

The Care Transitions Intervention

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00244491
• Other study ID #: 00-1036
• Status: Completed
• Phase: N/A
• First received: October 24, 2005
• Last updated: August 10, 2015
• Start date: September 2002
• Est. completion date: August 2003

Study information

• Verified date: August 2015
• Source: University of Colorado, Denver
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

This intervention tests whether encouraging older patients and their caregivers to assert a more active role in their care transitions could improve clinical outcomes. Patients are supported by a nurse transition coach and specific tools, including a Personal Health Record.

Description:

See above.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1400
• Est. completion date: August 2003
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 65 Years and older

Eligibility

Inclusion Criteria:

• To be eligible for this study, patients from the participating delivery system had to: 1) be age 65 years or older, 2) be admitted to one of the participating delivery system's contract hospitals during the study period for a non-psychiatrically-related condition, 3) be community-dwelling (i.e., not from a long-term care facility), 4) reside within a predefined geographic radius of the hospital (thereby making a home visit feasible), 5) have a working telephone, 6) be English-speaking, 7) show no documentation of dementia in the medical record, 8) have no plans to enter hospice, 9) not be participating in another research protocol, and 10) have documented in their medical record at least one of 11 diagnoses, including stroke, congestive heart failure, coronary artery disease, cardiac arrhythmias, chronic obstructive pulmonary disease, diabetes, spinal stenosis, hip fracture, peripheral vascular disease, deep venous thrombosis, or pulmonary embolism.

Exclusion Criteria:

• Those who did not meet the inclusion criteria.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label

Related Conditions & MeSH terms

• Continuity of Patient Care

Intervention

Behavioral:
• Care Transitions Intervention

Locations

Country	Name	City	State
United States	University of Colorado Health Sciences Center	Denver	Colorado

Sponsors (2)

Lead Sponsor	Collaborator
University of Colorado, Denver	The John A. Hartford Foundation

Country where clinical trial is conducted

United States, 

References & Publications (1)

Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006 Sep 25;166(17):1822-8. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Rehospitalization rate at 30, 90 and 180 days after index hospitalization.
Secondary	Rehospitalization rate at 30, 90 and 180 days after index hospitalization. Rehospitalization for the same condition as the index hospital stay, at 30, 90 and 180 days.