Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT04248738 |
| Other study ID # |
00126445 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
February 4, 2020 |
| Est. completion date |
August 16, 2022 |
Study information
| Verified date |
August 2022 |
| Source |
University of Utah |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
The goal of NEEDS is to systematically identify patients' needs and resources at home to
inform discharge planning by health care teams. We believe the process of conducting such an
assessment during hospitalization will integrate the patient's voice and improve patient
outcomes by improving the team communication, quality of discharge planning, length of stay,
post-discharge outcomes (e.g., satisfaction), and readmissions.
Description:
As much as $17 billion could be saved annually by identifying patients at risk for hospital
readmission, and better supporting them during their "transitions" home. However, current
interventions aiming to decrease readmissions are limited by the fact that the most
frequently used risk models relying on clinical and administrative data fail to identify a
significant number of patients readmitted. A potential reason for the limited power of models
seeking to identify those at risk for readmission is that they fail to incorporate
patientcentered factors associated with health outcomes. Research continues to document how
social needs (e.g. food and housing insecurity) and supportive resources (e.g. instrumental
social support) play important roles in health outcomes. Yet, while admissions assessment of
social needs and supportive resources is required for JCAHO and CMS, our previous research
identified that 1) conducting an assessment of patients' supportive resources (i.e.
instrumental social support) reveals information important to discharge planning (e.g.,
living alone, poor relationships with providers) otherwise unknown by inpatient teams; 2)
lack of agreement between patients and nurses regarding readiness for hospital discharge
(personal status, knowledge, coping ability, and expected support) is associated with patient
coping difficulties and readmissions; and 3) even in systems with dedicated discharge
planners (e.g., RN case managers, LCSWs), health team members involved in discharge planning
and education are frequently unaware of patients' social needs and supportive resources.
These findings suggest that facilitating communication between patients, family members, and
inpatient health care providers regarding patients' social needs and supportive resources
will improve patient outcomes (e.g., readiness for hospital discharge, readmissions).
However, we do not yet understand whether or how patients' social needs and supportive
resources inform clinical decision-making, and there are concerns about incorporating such
assessments into routine care without sufficient understanding of its impact on patients.
Therefore, the objective of this study is to provide inpatient health care teams with
information about patients' social needs and supportive resources, evaluating whether it
facilitates clinical decision-making, impacts readiness for hospital discharge and,
ultimately, reduces hospital readmission. We will use a pre-post design, with a segmented
regression (interrupted time series) analytic approach, to test the effect of communicating
results of a SocNSuppR assessment to medical and surgical inpatient teams during routine
discharge planning rounds, or the NEEDS intervention. The hypothesis is the incorporation of
patients' SocNSuppR information into inpatient care will result in higher and more congruent
readiness for hospital discharge ratings (between patients, family caregivers, and members of
the health care team) compared to patients without SocNSuppR assessment and communication.
The study's specific aims are:
Specific Aim 1. To test the effect of the NEEDS intervention (assessing patients' SocNSuppR
and communicating SocNSuppR to discharge teams) on patient- family caregiver- nurse-
provider- outcomes.
We will compare the following pre and post intervention: (1a) patient-reported readiness for
hospital discharge (primary outcome) and post-discharge coping difficulty (secondary
outcome), (1b) degree of congruence among readiness for hospital discharge ratings (among
patients, families, caregivers, nurses, and providers), and (1c) 7- and 30-day readmission
rates.
Specific Aim 2. To test the effect of the NEEDS intervention on discharge planning processes.
We will (2a) track changes in discharge plans based on SocNSuppR qualitatively through
clinical documentation, and (2b) compare documentation of designated caregiver teaching,
discharges before 11am, discharges before 2pm, time from discharge order to discharge, and
HCAHPS scores.
Specific Aim 3. To examine patient and provider experiences of the NEEDS intervention.
We will qualitatively examine patient- caregiver- and provider-reported barriers,
facilitators and recommendations for clinical adoption of the NEEDS protocol (SocNSuppR
assessment and communication).
