Transition cAre inteRvention tarGeted to High-risk patiEnts To Reduce rEADmission
- Conditions
- Patient Readmission
- Interventions
- Other: TARGET
- Registration Number
- NCT03496896
- Lead Sponsor
- Insel Gruppe AG, University Hospital Bern
- Brief Summary
Hospital rehospitalizations within 30 days are frequent and represent a burden for the patients, but also for the entire health care system. This study evaluates the impact of an intervention targeted to high-risk medical patients in order to reduce their risk of rehospitalization. Half of the patients will receive a set of interventions before and after their hospital discharge, while the other half will receive usual care.
- Detailed Description
Background: Hospital readmissions within 30 days are frequent, with rates varying usually between 12 and 20%. Is it therefore recognized as important to improve the quality of the transition of care period in order to avoid as much as possible hospital readmissions. There are however still several gaps in current knowledges. First, most trials to reduce hospital readmission have been performed on specific patient populations such as patients with diabetes or heart failure, and therefore the findings may not be well generalizable to other high-risk population. Second, while some specific interventions have been showed to reduce readmission, these were complex and resources demanding, and no trial targeted these interventions to the patients who are most likely to benefit for better effectiveness, using a widely validated prediction tool, such as the "HOSPITAL" score. Finally, most studies tested unimodal interventions instead of more promising multimodal interventions.
Specific aim: the goal of this proposal is to evaluate the effect of a multimodal transitional care intervention prioritized to higher-risk medical patients on the composite of 30-day unplanned readmissions and death.
Methods: the investigators will conduct a multicenter randomized controlled trial in medical inpatients discharged home or nursing home, who are identified as having a higher risk for 30-day readmission. Risk of readmission will be predicted using the simplified HOSPITAL score, which includes 6 variables routinely available before hospital discharge and which has been previously validated in more than 200,000 patients across 6 countries in its original version, and in nearly 120,000 patients in its simplified version. Patients will be randomly assigned to the intervention group or usual care group. The primary outcome will be the first 30-day unplanned readmission or all-cause mortality. The primary analysis will be a comparison between two groups according to the intention-to-treat principle.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1393
- Adult Patients planned to be discharged home/nursing home from a medical department.
- Hospital stay of at least 24 hours.
- Patient at higher risk of 30-day readmission based on the simplified HOSPITAL score.
- Previous enrolment in this trial.
- Patient is not living in the country in the next 30 days.
- No phone to be reached at.
- Not speaking the local language.
- Refusal to participate, or unable to give consent.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description "TARGET" intervention TARGET The intervention group will receive a standardized transition care intervention by a trained nurse composed of a pre-discharge component and 2 post-discharge follow-up phone calls 3 days and 14 days after discharge.
- Primary Outcome Measures
Name Time Method 30-day unplanned readmission or death 30 days after hospital discharge Number of patients who have a first unplanned readmission or die within 30 days after discharge (Composite endpoint).
- Secondary Outcome Measures
Name Time Method 30-day mortality 30 days after hospital discharge Number of patients who die (individual components of the primary composite outcome).
Post-discharge health care utilization 4 30 days after hospital discharge Number of primary care provider visits
Time to first unplanned readmission or death Within 30 days after hospital discharge Number of days between hospital discharge and first unplanned readmission or death.
Post-discharge health care utilization 1 30 days after hospital discharge Total number of readmission(s)
First 30-day unplanned readmission 30 days after hospital discharge Number of patients who have a first unplanned readmission (individual components of the primary composite outcome)
Patient's perspective (satisfaction) on quality of transition of care between hospital and home 30 days after hospital discharge Proportion of patients who are responding positively to all 3 items of the Three-Item Care Transition Measure (CTM-3)
Post-discharge health care utilization 2 30 days after hospital discharge Total number of days of hospitalizations within 30 days
Post-discharge health care utilization 3 30 days after hospital discharge Number of emergency room visits
Costs of readmission 30 days after hospital discharge Total costs of the rehospitalization in Swiss Francs (CHF)
Main cause of readmission or death 30 days after hospital discharge Proportion of most frequent main diagnosis for the readmission
Trial Locations
- Locations (4)
Hôpital cantonal Fribourg
🇨🇭Fribourg, Switzerland
Hôpital neuchâtelois
🇨🇭Neuchâtel, Switzerland
Centre hospitalier Bienne
🇨🇭Bienne, Bern, Switzerland
Centre hospitalier universitaire vaudois (CHUV)
🇨🇭Lausanne, Switzerland