An Electronic Multimedia Discharge Application

Hospital Inpatients Clinical Trial

Official title:

Video Assisted Transitions of Care: The Power of Video for Hospital Discharge Process

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02752321
• Other study ID #: 15-260
• Status: Terminated
• Phase: N/A
• First received: April 15, 2016
• Last updated: January 8, 2018
• Start date: August 2016
• Est. completion date: December 2017

Study information

• Verified date: January 2018
• Source: Northwell Health
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to determine whether the addition of a mobile or web based multimedia discharge application (eDischarge) to the discharge process is effective in improving patient experience, engagement, and clinical outcomes in the early post discharge period.

Description:

Hospital discharge is an essential transition of a patient's care from the inpatient health care team to the patient and caregiver. While a variety of factors may contribute to the effective discharge process, adequate communication between all parties significantly contributes to better outcomes. However, studies indicate that nearly one in five Medicare patients are re-hospitalized within one month of discharge due to lack of patient understanding and compliance to the post-hospital plan of care.

The standard discharge process, which is similar across all disease etiologies, has not changed significantly in many years and lags behind today's technological advances. Currently, the standard discharge process most commonly is delivered as a written document. This document summarizes the patient's hospitalization and discharge instructions in a plain text format, not significantly personalized, and is reviewed with the patient and caregivers usually at time of the discharge. Patients may not pay attention or understand the clinical information communicated to them and may not remember the dialogues during the discharge. In addition, patients often misplace their discharge papers and will not follow the post discharge instructions.

In early 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was adopted to promote the meaningful use of health information technology. Stage 1 of HITECH centered on 5 underlying health outcomes of meaningful use: (1) improve quality, safety, efficiency, and reduce health disparities; (2) engage patients and families in their healthcare; (3) improve care coordination; (4) improve population and public health; and (5) ensure adequate privacy and security protections for personal health information. While the passage of HITECH and application of new database technologies has prompted an increase in the use of electronic health records (EHR), the incentives of meaningful use has not been widely applied (Hsiao and Hing)3.

The current "Age of the Internet" and its ability to deliver data to almost any physical locale instantaneously, including high resolution audio and video, has fostered new ways to create, view and share information - including, potentially, medical records. eDischarge is a new multimedia technology designed to supplement the discharge process and enhance provider-patient communication by facilitating the delivery of discharge and follow-up information to patients. Designed as a secure, HIPPA-compliant, cloud-based software platform, participants are able to access the eDischarge system using a personal computer or a mobile device, which can enhance access to health information for the patient. Through eDischarge, participants are given personalized videos, documents, and images tailored specifically to their particular medical care. eDischarge permits inclusion of both structured health information exchange data as well as medical data to be added to discharge. Providers are able to asynchronously create content throughout a participant's hospital stay, which the participant will be able to access post discharge. The investigators believe that this technology has the potential to improve patient engagement and experience as well as enhance a patient's understanding of his disease process and treatment.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 117
• Est. completion date: December 2017
• Est. primary completion date: December 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Male and female patients ages 18 years and above

• Access to mobile device (phone/tablet) and/or computer at home

• Admission to Lenox Hill Hospital under the Department of Neurosurgery

• Discharge to home and rehab facilities where patients can be accessed

Exclusion Criteria:

• Irreversible impaired brain stem function (bilateral fixed, dilated pupils and extensor motor posturing)

• Patients not expected to survive to the 30 day visit due to co-morbidities or are Do No Resuscitate/Do Not Intubate (DNR/DNI) status prior to randomization

• Patients transferred to a different hospital service or a nursing home

• Patients on hospital precautions or suicide watch, or are deaf or blind

• Any concurrent serious illness that would interfere with the outcome assessments including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, immunologic, and hematologic disease.

• Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational technology were initiated.

Related Conditions & MeSH terms

• Hospital Inpatients

Intervention

Device:
• eDischarge
Patients will be enrolled in the eDischarge technology during their inpatient hospital stay. A completed electronic discharge packet (EDP) will be given to patients on the day of hospital discharge.

Locations

Country	Name	City	State
United States	Lenox Hill Hospital	New York	New York

Sponsors (1)

Lead Sponsor	Collaborator
Northwell Health

Country where clinical trial is conducted

United States, 

References & Publications (4)

Berkman ND, Dewalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and health outcomes. Evid Rep Technol Assess (Summ). 2004 Jan;(87):1-8. Review. — View Citation

Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003 Feb 4;138(3):161-7. — View Citation

Hsiao CJ, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2013. NCHS Data Brief. 2014 Jan;(143):1-8. — View Citation

Lai M, Kheterpal S. Creating a real return-on-investment for information system implementation: life after HITECH. Anesthesiol Clin. 2011 Sep;29(3):413-38. doi: 10.1016/j.anclin.2011.05.005. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Post Discharge Survey	to determine patient knowledge/awareness of their diagnosis	7-14 Days Post-Discharge
Primary	Post Discharge Survey	to determine patient knowledge/awareness of their medications	7-14 Days Post-Discharge
Secondary	Patient Discharge Experience (eDischarge Questionnaire)	to compare patients experiences with their discharge between the SDeD and the SD groups.	7-14 Days Post-Discharge
Secondary	Patient Discharge Experience (Standard Discharge Questionnaire)	to compare patients experiences with their discharge between the SDeD and the SD groups.	7-14 Days Post-Discharge
Secondary	Hospital Readmission Rate	to compare readmission rates between the SDeD and SD groups.	30-45 Days Post Discharge
Secondary	ED Visit Rate	to compare emergency department visit rates between the SDeD and SD groups.	30-45 Days Post Discharge