Impact of Implementing a Real Time Frequent Admitter Risk Score (FAM-FACE-SG) on Readmission Rates

Patient Readmission Clinical Trial

— FAMFACESGRCT  

Official title:

Impact of Implementing a Real Time Frequent Admitter Risk Score (FAM-FACE-SG) on Readmission Rates: a Pragmatic Cluster Randomised Controlled Trial (RCT).

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT02815462
• Other study ID #: SGH_OIC_FAMFACESG/5/2016
• Status: Withdrawn
• Phase: N/A
• Start date: August 2016
• Est. completion date: August 2017

Study information

• Verified date: April 2023
• Source: Singapore General Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

In an earlier study using electronic health records (EHR), the investigators have identified nine factors to be significantly associated with FA risk. These nine predictors include Furosemide intravenous 40 milligrams or more; Admissions in the past one year; Medifund status; Frequent emergency department use; Anti-depressants treatment in past one year; Charlson comorbidity index; End Stage Renal Failure on dialysis; Subsidized ward stay and Geriatric patient. The investigators have combined these nine predictors into the FAM-FACE-SG score for FA risk (defined as 3 or more inpatient admissions in the following 12 months). The FAM-FACE-SG risk score has the advantage of being deployed in our hospital's enterprise data repository known as Electronic Health Intelligence System or eHINTs for short, on a real-time or near real-time basis. On a daily basis, data from multiple data sources are extracted, transformed and loaded onto the eHINTS system. The system can be programmed to run every midnight to provide risk scores the following morning for patients admitted the previous day. In this trial, the intervention is to combine the FAM-FACE-SG risk score in addition to a decision making algorithm to guide referrals to various transitional care services based on needs assessment on nursing and function. The primary objective is to evaluate the impact of our intervention in improving healthcare utilization (hospital readmissions, emergency department (ED) attendances, length of stay up to 90 days post-discharge).

Description:

In an earlier study using electronic health records (EHR), The investigators have identified nine factors to be significantly associated with FA risk. These nine predictors include Furosemide intravenous 40 milligrams or more; Admissions in the past one year; Medifund status; Frequent emergency department use; Anti-depressants treatment in past one year; Charlson comorbidity index; End Stage Renal Failure on dialysis; Subsidized ward stay and Geriatric patient. The investigators have combined these nine predictors into the FAM-FACE-SG score for FA risk (defined as 3 or more inpatient admissions in the following 12 months). The FAM-FACE-SG risk score has the advantage of being deployed in our hospital's enterprise data repository known as Electronic Health Intelligence System or eHINTs for short, on a real-time or near real-time basis. On a daily basis, data from multiple data sources are extracted, transformed and loaded onto the eHINTS system. The system can be programmed to run every midnight to provide risk scores the following morning for patients admitted the previous day. In this trial, the intervention is to combine the FAM-FACE-SG risk score in addition to a decision making algorithm to guide referrals to various transitional care services based on needs assessment on nursing and function. The primary objective is to evaluate the impact of our intervention in improving healthcare utilization (hospital readmissions, emergency department (ED) attendances, length of stay up to 90 days post-discharge). The aims of this cluster RCT are to: (1) evaluate the impact of implementing the FAM-FACE-SG risk score in addition to a decision making algorithm to guide Patient Navigator (PN) referrals to various transitional care services based on needs assessment on nursing and function on improving healthcare utilization (hospital readmissions, emergency department (ED) attendances, length of stay up to 90 days post-discharge); (2) measure the implementation of the risk score (Fidelity of the PNs in adhering to the protocol in recruiting patients according the score priority; Referral rate of the PNs to various transitional care services; Qualitative feedback from PNs on the perceived benefits and behavior change after receiving the scores); (3) conduct an economic analysis of the cost-benefit of implementing the risk score.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: August 2017
• Est. primary completion date: August 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 21 Years and older

Eligibility

Inclusion Criteria:

• Singapore General Hospital wards with patient navigators
• Patients who are frequent admitters (defined as 3 or more hospital admissions in the preceding 12 months)

Exclusion Criteria:

• Haematology, Oncology, Emergency department, obstetrics and neonatology wards

Related Conditions & MeSH terms

• Patient Readmission

Intervention

Other:
• FAMFACESG
- PNs will receive the FAM-FACE-SG FA risk scores for frequent admitters admitted to their ward.
• Control
- Usual hospital Care
• FAMFACESG
- PNs will be instructed to prioritize intervention of frequent admitters for intervention based on the FA risk score.
• FAMFACESG
For high and moderate risk patients who do not require transitional home care (THC), PN will do the case management and follow up. For high and moderate risk patients & have complex nursing and / or high functional needs, PNs will refer these patients for THC. For mild risk patients, PNs will refer them to care coordinator.
• FAMFACESG
- For low risk patients, PNs will continue usual hospital care.

Locations

Country	Name	City	State
Singapore	Singapore General Hospital	Singapore

Sponsors (1)

Lead Sponsor	Collaborator
Singapore General Hospital

Country where clinical trial is conducted

Singapore, 

References & Publications (5)

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009 Apr 2;360(14):1418-28. doi: 10.1056/NEJMsa0803563. Erratum In: N Engl J Med. 2011 Apr 21;364(16):1582. — View Citation

Kripalani S, Theobald CN, Anctil B, Vasilevskis EE. Reducing hospital readmission rates: current strategies and future directions. Annu Rev Med. 2014;65:471-85. doi: 10.1146/annurev-med-022613-090415. Epub 2013 Oct 21. — View Citation

Longman JM, I Rolfe M, Passey MD, Heathcote KE, Ewald DP, Dunn T, Barclay LM, Morgan GG. Frequent hospital admission of older people with chronic disease: a cross-sectional survey with telephone follow-up and data linkage. BMC Health Serv Res. 2012 Oct 30 — View Citation

Low LL, Vasanwala FF, Ng LB, Chen C, Lee KH, Tan SY. Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study. BMC Health Serv Res. 2015 Mar 14;15:100. doi: 10.1186/s12913-015-0750-2. — View Citation

Robst J. Developing Models to Predict Persistent High-Cost Cases in Florida Medicaid. Popul Health Manag. 2015 Dec;18(6):467-76. doi: 10.1089/pop.2014.0174. Epub 2015 Jun 23. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	90-day readmission rate		90 days
Secondary	30-day readmission rate		30 days
Secondary	30-day ED attendance rate		30 days
Secondary	90-day ED attendance rate		90 days
Secondary	index hospital admission length of stay		90 days
Secondary	cumulative length of stay 90 days after index hospital discharge		90 days
Secondary	Fidelity of the PNs in following the protocol in recruiting patients according the score priority		90 days
Secondary	Proportion of high and medium risk patients recruited in both intervention and control groups		90 days
Secondary	Referral rate of the PNs to various transitional care services		90 days
Secondary	Qualitative feedback from PNs on the perceived benefits and behaviour change after receiving the scores	Questionnaire survey	1 year