Comparison Between Two Strategies of Discharge Planning for the Reduction of Short Term Hospital Readmissions

Patient Discharge Clinical Trial

— PROMENADE  

Official title:

Comparison Between Two Strategies of Discharge Planning for the Reduction of Short Term Hospital Readmissions: A Cluster Randomized Cross-over Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03436940
• Other study ID #: CS2/378/2017
• Status: Completed
• Phase: N/A
• Start date: June 1, 2018
• Est. completion date: October 13, 2019

Study information

• Verified date: March 2022
• Source: Azienda Ospedaliera Città della Salute e della Scienza di Torino
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to improve discharge planning effectiveness by comparing two strategies [on-Demand Discharge Planning (DDP) vs. Routine Discharge Planning (RDP)], in terms of reduction of hospital readmissions for inpatients classified at intermediate risk of complex discharge using the simplified Blaylock Risk Assessment Screening Score (BRASS).

Description:

The purpose of this study is to improve discharge planning effectiveness by comparing two strategies [on-Demand Discharge Planning (DDP) vs. Routine Discharge Planning (RDP)], in terms of reduction of hospital readmissions for inpatients classified at intermediate risk of complex discharge using the simplified Blaylock Risk Assessment Screening Score (BRASS).

Five Internal Medicine Unit and four Units of Neurology will be randomized to the two different strategies of discharge planning (RDP or DDP), based on two different alternating sequences of four periods (each period comprising three months). The randomization will be stratified by type of unit.

Patients at risk of complex discharge, according to the simplified BRASS score, are assigned to the Hospital Unit of Continuity of Care (NOCC) team, using the hospital telematics system. Afterwards, the NOCC team proposes an appropriate discharge planning, considering clinical and social needs.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 802
• Est. completion date: October 13, 2019
• Est. primary completion date: October 12, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adults patients (age = 18 years);

• Residents in Piedmont, Italy;

• Patients admitted to General Internal Medicine or Neurology Units of Molinette Hospital (Turin)

• Patients with a score in the simplified BRASS between 4 and 6 at admission

No specific exclusion criteria were applied.

Related Conditions & MeSH terms

• Patient Discharge

Intervention

Other:
• On Demand Discharge Planning (DDP)
Patients with an intermediate score, according to the simplified Blaylock Risk Assessment Screening Score, are addressed to the NOCC team (hospital Continuity of care team) only in case of a specific request by the unit of hospitalization.
• Routine Discharge Planning (RDP)
All patients with an intermediate threshold value of the simplified Blaylock Risk Assessment Screening Score are submitted to discharge planning by the NOCC team (Hospital Unit of Continuity of Care)

Locations

Country	Name	City	State
Italy	AOU Città della Salute	Torino

Sponsors (1)

Lead Sponsor	Collaborator
Azienda Ospedaliera Città della Salute e della Scienza di Torino

Country where clinical trial is conducted

Italy, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Unexpected hospital readmission within 90 days from discharge	Proportion of hospital admissions in the standard admission regime within 90 days from the date of discharge. The endpoint will be calculated only for patients discharged alive. Readmissions for any cause under ordinary admissions will be considered as event. The Day Hospital re-admissions will not be considered for the endpoint calculation.	90 days
Secondary	Proportion of Long Length of Stay (LLOS)	Proportion of admissions with long duration of hospitalization (LLOS - Long Length of Stay). The endpoint will be calculated for all hospitalized patients. An admission will be considered as LLOS if its duration will be higher than the 90th specific percentile for Diagnostic Related Group (DRG ) detected at the regional level in Piedmont in 2016.	150 days
Secondary	Death within 90 days from discharge	Proportion of deaths within 90 days of discharge date. The endpoint will be calculated only for patients discharged alive. Death for any cause will be considered as event.	90 days
Secondary	Proportion of patients reported to the NOCC team during the DDP-experimental phase	Incidence of activations of the NOCC in the periods of adoption of the DDP strategy (only for admissions treated with DDP strategy)	150 days
Secondary	Healthcare costs until 90 days from the discharge	Health care costs charged to the National Health Service (NHS) between the date of admission and 90 days from the date of discharge or death of the patient.	90 days