Post-Acute Physician Home Visits: A Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- A Patient Discharged From an Acute-care Hospital Who Had an Acute Illness
- Sponsor
- Brigham and Women's Hospital
- Enrollment
- 51
- Locations
- 2
- Primary Endpoint
- New or worsening symptoms
- Status
- Completed
- Last Updated
- 6 years ago
Overview
Brief Summary
New or worsening symptoms following discharge from the hospital likely leads to unplanned readmission. These rates are higher than desired and costly to patients, payers, and providers. Many interventions have unsuccessfully attempted to reduce readmissions, but few have provided in-home personnel to patients transitioning from acute care back to ambulatory care. Still fewer have involved a physician in the home. We therefore will test the effect of a physician home visit to a patient's home who was discharged in the last 4 days.
Investigators
Jeffrey L. Schnipper, MD.,MPH.
Associate Professor
Brigham and Women's Hospital
Eligibility Criteria
Inclusion Criteria
- •Resides within either a 5-mile or 20-minute driving radius of Brigham and Women's Hospital (BWH) or Brigham and Women's Faulkner Hospital (BWFH) emergency room
- •Has capacity to consent to study
- •\>=18 years old
Exclusion Criteria
- •Undomiciled
- •In police custody
- •Domestic violence screen positive
Outcomes
Primary Outcomes
New or worsening symptoms
Time Frame: 30 days after discharge from hospital
"Since you got home from the hospital, have you had any symptoms at all?" If no, stop. If yes, continue. "I'm going to read off a list of symptoms, and I want you to tell me if that symptom is new or has gotten worse since you left the hospital. Please don't include symptoms that have stayed the same since you were in the hospital." For each affirmative, double check if the symptom is new or has gotten worse since getting out of the hospital. Only if new or worse, mark yes.
Secondary Outcomes
- Receipt of prescribed medicines following discharge, y/n(30 days after discharge)
- Primary care provider follow-up within 14 days, y/n(Day of discharge to 14 days later)
- Total reimbursement, 30-days post discharge(Day of discharge to 30 days later)
- Total cost, 30-days post discharge(Day of discharge to 30 days later)
- Ability to carry out the discharge plan, score(30 days after discharge)
- 3-item Care Transition Measure, score(30 days after discharge)
- Change in medication list due to home visit, y/n(Day of home visit)
- Unplanned 30-day readmission(s) after index hospitalization, #(30 days after discharge)
- Unplanned 30-day readmission(s) after index hospitalization, y/n(30 days after discharge)