Tools to Improve Discharge Equity (TIDE) Pilot RCT
- Conditions
- Hospital Discharge
- Interventions
- Other: Toolkit to improve discharge equity
- Registration Number
- NCT05988229
- Lead Sponsor
- Boston Medical Center
- Brief Summary
The investigators will test the impact of a package of linguistically appropriate discharge teaching tools against current standard of care for patients with Limited English proficiency (LEP) in an unblinded randomized controlled trial. The tools include an expanded medication calendar in English and the patients' preferred language, pictographics to illustrate return precautions (what signs/symptoms require further evaluation), an audio recording of the nurse reviewing the After Visit Summary (composed by providers) to allow for review by patients and caretakers after discharge.
The investigators will evaluate the effectiveness of the package of discharge teaching tools on patients' understanding/recall, key implementation outcomes, and secondary clinical outcomes via a structured interview 1-2 weeks after discharge and chart review 30 days after discharge.
The objectives of this research study are:
1. test the effectiveness of a linguistically appropriate toolkit for improving patient understanding of discharge instruction content
2. Assess the feasibility and fidelity of the intervention in anticipation of a multi-site implementation trial
3. assess the feasibility and appropriateness of the linguistically appropriate toolkit to nurses and in-person interpreters
4. to assess the acceptability of the intervention to patients and their satisfaction with it
5. to collect data on implementation context in anticipation for a multi-site trial
6. to collect preliminary data on the toolkit's impact on clinical outcomes including medication adherence and hospital re-utilization.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 104
Patients
- Labeled in medical record as preferring one of the following four languages: Spanish, Haitian Creole, Cape Verdean Creole, or Vietnamese
- Admitted to medicine team at BMC
- Age 18 years or older
- Being discharged home (to the community)
- Admitted to Boston Medical Center (BMC) hospital units (Menino 7 East, 7 West, and Menino Observation)
Nurses and Interpreters
- Caring for patient enrolled in trial
Family/Visitors
- Present at time of discharge for patient enrolled in trial
Patients
- On airborne infections precautions
- On clostridium difficile (C diff) precautions
- On suicide precautions
- Nurse report of participant displaying cognitive impairment, delirium, or aggression
- Enrolled in trial during a prior admission
Nurses and Interpreters
- None
Family/Visitors
- None
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Discharge equity tools Toolkit to improve discharge equity Participants randomized into this arn will receive the toolkit of linguistically appropriate discharge teaching aids at hospital discharge.
- Primary Outcome Measures
Name Time Method Patient understanding of primary diagnosis of hospitalization 1-2 weeks post discharge Determined by two physician adjudicators (1=poor, 4 = near perfect). Higher scores demonstrate better understanding.
Patient understanding of discharge instructions 1-2 weeks post discharge Assessed by a composite score of six key domains of discharge instructions (primary diagnosis, self-care instructions, return precautions, medication changes, medication indications, follow-up) as determined by two physician adjudicators (1=poor, 4 = near perfect). Higher scores demonstrate better understanding.
- Secondary Outcome Measures
Name Time Method Implementation effectiveness 18 months Effectiveness will be assessed by observations of and comments from patients, nurses and visitors from qualitative interviews related to the adoption, acceptability, appropriateness, and feasibility of the discharge process
Hospital re-utilization 30 days Assessed by a combined outcome of admission or emergency department (ED) visit within 30 days of index discharge
Number of participants with completion of primary care follow-up 30 days Assessed from participants' medical records
Participant participation in discharge teaching 1-2 weeks Participants are observed by a research team member during discharge teaching and will document the number of questions asked.
Trial Locations
- Locations (1)
Boston Medical Center
🇺🇸Boston, Massachusetts, United States