Transport PLUS Intervention

Fall Clinical Trial

Official title:

Randomized Controlled Trial Evaluating Efficacy of EMS Providers Performing Discharge Comprehension and Home Fall Hazard Assessments

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03046771
• Other study ID #: GCO 14-1842
• Secondary ID: 1R03AG050917-01
• Status: Completed
• Phase: N/A
• Start date: January 19, 2017
• Est. completion date: May 30, 2019

Study information

• Verified date: January 2020
• Source: Icahn School of Medicine at Mount Sinai
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Hypothesis: 'Transport PLUS,' a low cost, easily generalizable intervention performed by Emergency Medical Technicians while transporting a patient home from the hospital, can improve transitions of care and improve patient safety following hospitalization as measured by decreased rates of falls and reduced rates of return to the hospital.

Description:

The moment of transition between the hospital and the home is susceptible to lapses in quality and loss of key information regarding a patient's care. An increasing amount of attention is being given to improving the transition of care by targeting factors that contribute to return Emergency Department (ED) visits and readmissions. Following a hospitalization, as many as 40% of patients over age 60 will experience a fall in the subsequent six months and 76% of older adult patients are uncertain about their follow-up care plan. Patients transported home by ambulance following an ED visit were found to have a significantly higher rate of return ED visits at 30 days then overall rates for older adult ED patients (27.8% vs. 11.5%).

In response to these challenges, the researcher's study group developed and piloted an innovative care model known as "Transport PLUS" in which specially trained emergency medical technicians (EMTs) who are already transporting an older adult (65+ years in age) patient home from the ED add to their service two simple interventions - a home fall hazard assessment (FHA) and a discharge comprehension assessment (DCA). Both interventions are facilitated and measured using a checklist developed through a systematic review of the literature and existing tools, and later refined through EMT and patient focus groups.

This study will test the hypothesis that 'Transport PLUS,' a low cost, easily generalizable intervention, can improve transitions of care and improve patient safety following hospitalization as measured by decreased rates of falls and reduced rates of return to the hospital.

The researchers will conduct a pilot cluster randomized controlled trial comparing the Transport PLUS intervention to standard care in a population of older adult patients being discharged from the hospital. The researchers will randomize EMS providers to either perform Transport PLUS (the intervention) or to provide routine transport. It is estimated that approximately 400 patients over age 65 will be transported home from the study hospital by participating providers during the study enrollment period. Patient participants will receive Transport PLUS (n=200) or routine care (n=200) as determined by the transporting provider. Primary outcomes will be the rate of falls in the 3 months following hospitalization and 3-day and 30-day return ED visits (with or without a hospitalization). Process measures will include removal of fall hazards at 3 months and compliance with discharge instructions. Extending beyond the grant period, the researchers intend to follow the cohort for up to 1 year.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 58
• Est. completion date: May 30, 2019
• Est. primary completion date: August 23, 2018
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Emergency Medical Technicians (EMTs) are eligible to participate in study if

• employed by Hunter EMS

• over the age of 18 years, and

• certified as an EMT in New York State.

Patient participants are eligible if

• over the age of 65 years

• being discharged from the study hospital, and

• being transported directly to home.

Exclusion Criteria:

• EMTs who expect to leave the job in less than 1 year

• EMTs who have been previously trained in Transport PLUS.

Related Conditions & MeSH terms

• Emergencies
• Emergency Medical Services
• Fall
• Fall, Accidental
• Hospital Readmission

Intervention

Behavioral:
• Transport PLUS group
The Transport Plus EMTs will offer to perform the FHA and DCA for all transports of patients aged 65 or older, who are being transported from The Mount Sinai Hospital to a private residence.

Locations

Country	Name	City	State
United States	Icahn School of Medicine at Mount Sinai	New York	New York

Sponsors (2)

Lead Sponsor	Collaborator
Icahn School of Medicine at Mount Sinai	National Institute on Aging (NIA)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Rate of falls	Rate of falls following transport home by ambulance	up to 3 months
Primary	Rate of return ED visits	Rate of return ED visits following transport home by ambulance	30 days
Secondary	Rate of falls		up to 12 months
Secondary	Rate of return ED visits	Numbers of patients with ED visits within 3 days of participation in study intervention or control arm.	3 days
Secondary	Readmission	Numbers of patients with readmissions after study intervention	up to 90 days