Post-Acute Physician Home Visit Program

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

Official title:

Post-Acute Physician Home Visits: A Randomized Controlled Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03178513
• Other study ID #: P000719
• Status: Completed
• Phase: N/A
• Start date: June 6, 2017
• Est. completion date: January 20, 2018

Study information

• Verified date: August 2019
• Source: Brigham and Women's Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 51
• Est. completion date: January 20, 2018
• Est. primary completion date: January 20, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

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

Related Conditions & MeSH terms

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

Intervention

Other:
• Home visit
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

Locations

Country	Name	City	State
United States	Brigham and Women's Faulkner Hospital	Boston	Massachusetts
United States	Brigham and Women's Hospital	Boston	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
Brigham and Women's Hospital

Country where clinical trial is conducted

United States, 

References & Publications (6)

Boling PA. Care transitions and home health care. Clin Geriatr Med. 2009 Feb;25(1):135-48, viii. doi: 10.1016/j.cger.2008.11.005. Review. — View Citation

Branowicki PM, Vessey JA, Graham DA, McCabe MA, Clapp AL, Blaine K, O'Neill MR, Gouthro JA, Snydeman CK, Kline NE, Chiang VW, Cannon C, Berry JG. Meta-Analysis of Clinical Trials That Evaluate the Effectiveness of Hospital-Initiated Postdischarge Interventions on Hospital Readmission. J Healthc Qual. 2017 Nov/Dec;39(6):354-366. doi: 10.1097/JHQ.0000000000000057. Review. — View Citation

Epstein K, Juarez E, Loya K, Gorman MJ, Singer A. Frequency of new or worsening symptoms in the posthospitalization period. J Hosp Med. 2007 Mar;2(2):58-68. — View Citation

Meyer GS, Gibbons RV. House calls to the elderly--a vanishing practice among physicians. N Engl J Med. 1997 Dec 18;337(25):1815-20. — View Citation

Wolff JL, Meadow A, Boyd CM, Weiss CO, Leff B. Physician evaluation and management of Medicare home health patients. Med Care. 2009 Nov;47(11):1147-55. doi: 10.1097/MLR.0b013e3181b58e30. — View Citation

Wong FK, Chow SK, Chan TM, Tam SK. Comparison of effects between home visits with telephone calls and telephone calls only for transitional discharge support: a randomised controlled trial. Age Ageing. 2014 Jan;43(1):91-7. doi: 10.1093/ageing/aft123. Epub 2013 Aug 26. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Global satisfaction with care, score	Exploratory	30 days after discharge
Other	Days at home since discharge, #	Exploratory	30 days after discharge
Other	All-cause 30-day readmission(s) after index hospitalization, y/n	Exploratory	30 days after discharge
Other	All-cause 30-day readmission(s) after index hospitalization, #	Exploratory	30 days after discharge
Other	Emergency Department (ED) observation stay(s) after index hospitalization, y/n	Exploratory	30 days after discharge
Other	Emergency Department (ED) observation stay(s) after index hospitalization, #	Exploratory	30 days after discharge
Other	Emergency Department (ED) visit(s) after index hospitalization, #	Exploratory	30 days after discharge
Other	Emergency Department (ED) visit(s) after index hospitalization, y/n	Exploratory	30 days after discharge
Other	Imaging, #	Exploratory	30 days after discharge
Other	Imaging, y/n	Exploratory	30 days after discharge
Other	Lab orders, #	Exploratory	30 days after discharge
Other	Lab orders, y/n	Exploratory	30 days after discharge
Other	Physician visits, y/n	Exploratory	30 days after discharge
Other	Physician visits, #	Exploratory	30 days after discharge
Other	Home health utilization, days	Exploratory	30 days after discharge
Other	Home health utilization, y/n	Exploratory	30 days after discharge
Other	All cause 30-day mortality, y/n	Exploratory	30 days after discharge
Other	Unplanned 30-day mortality, y/n	Exploratory	30 days after discharge
Other	Change in medication list due to error at discharge, y/n	Exploratory	Visit date
Other	Pneumococcal vaccination if appropriate, y/n	Exploratory	30 days after discharge
Other	Influenza vaccination if appropriate, y/n	Exploratory	30 days after discharge
Other	Smoking cessation counseling if appropriate, y/n	Exploratory	30 days after discharge
Other	Evaluation of ejection fraction as assessed by echocardiogram or other appropriate study, scheduled or completed, if not done within 1 year; y/n	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	30 days after discharge
Other	Angiotensin converting enzyme inhibitor or angiotensin receptor blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n	Heart failure patients only; Exploratory	30 days after discharge
Other	Beta blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n	Heart failure patients only; Exploratory	30 days after discharge
Other	Aldosterone antagonist for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n	Heart failure patients only; Exploratory	30 days after discharge
Other	Lipid lowering for coronary artery disease, peripheral vascular disease, cerebrovascular accident, or diabetes, y/n	Heart failure patients only; Exploratory	30 days after discharge
Other	Smoking status post-discharge	Heart failure patients only; Exploratory	30 days after discharge
Other	Use of inappropriate medications in the elderly, y/n	Exploratory; using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Beers criteria	30 days after discharge
Other	Time between discharge and visit, days	Exploratory	Date of home visit
Other	Duration of physician visit, minutes	Exploratory	Date of home visit
Primary	New or worsening symptoms	"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.	30 days after discharge from hospital
Secondary	Total cost, 30-days post discharge		Day of discharge to 30 days later
Secondary	Total reimbursement, 30-days post discharge		Day of discharge to 30 days later
Secondary	3-item Care Transition Measure, score		30 days after discharge
Secondary	Primary care provider follow-up within 14 days, y/n		Day of discharge to 14 days later
Secondary	Ability to carry out the discharge plan, score	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.	30 days after discharge
Secondary	Change in medication list due to home visit, y/n	Physician-initiated medication change during home visit	Day of home visit
Secondary	Receipt of prescribed medicines following discharge, y/n	Pharmacy confirmation	30 days after discharge
Secondary	Unplanned 30-day readmission(s) after index hospitalization, y/n		30 days after discharge
Secondary	Unplanned 30-day readmission(s) after index hospitalization, #		30 days after discharge