Fall Clinical Trial
Official title:
Randomized Controlled Trial Evaluating Efficacy of EMS Providers Performing Discharge Comprehension and Home Fall Hazard Assessments
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.
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.
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