Quasi-Randomized Evaluation of the UCLA Next Day Clinic (NDC)

Not Applicable

Recruiting

• Conditions: Pneumonia; Osteomyelitis; Syncope; Pyelonephritis; Congestive Heart Failure; Diabetic Foot Infection; Cellulitis; AKI - Acute Kidney Injury

• Registration Number: NCT06526884
• Lead Sponsor: University of California, Los Angeles

Brief Summary

The Next Day Clinic (NDC) is a quality improvement initiative that will be launched and operated by UCLA Health starting July 22, 2024. Its goals are to improve patient care and safety and to maximize cost effectiveness. The way it does this is by identifying patients in the ED who would normally be admitted for low-acuity conditions, and diverting them to a high-acuity clinic the following day called the NDC. This will help decompress the ED and the hospital, and allow for overall higher quality care. The Health System has partnered with UCLA's Healthcare Value Analytics and Solutions \[UVAS\] group which specializes in these types of program evaluations. The analysis conducted by the study team will be used to directly inform NDC operations, scaling, and future plans.

Detailed Description

NDC is a hospital avoidance model with the potential to simultaneously improve the quality and safety of acute care, reduce costs, and address hospital/ED overcrowding. This novel hospital avoidance program will divert patients from the ED who have been diagnosed with the following conditions and meet certain clinical criteria:

* Diabetic Foot Infection/Osteomyelitis

* Cellulitis

* Congestive Heart Failure

* Syncope

* Pyelonephritis/Urinary Tract Infection

* Pneumonia

* Acute Kidney Infection

Study Timeline

• Study First Submitted: 2024-07-17
• Study Start: 2024-07-22
• Study First Submitted QC: 2024-07-24
• Study First Posted: 2024-07-30
• Status Verified: 2024-10
• Last Update Submitted: 2024-10-25
• Last Update Posted: 2024-10-29
• Primary Completion: 2025-11-30
• Study Completion: 2025-11-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 1080

Inclusion Criteria

• 18 years of age or older
• About to be admitted through the ED for one of the NDC diagnoses or a synonym (per Study Protocol document), defined by the presence of a Plan to Admit order or Bed Request order, OR recently admitted under observation or inpatient status for one of the NDC diagnoses.
• Identified as at-risk for an avoidable hospitalization in the ED based on a pre-determined set of lab and vital parameters.
• Insurance that authorizes the patient to follow-up at UCLA Health, or self-pay
• Admitted or being admitted to an internal medicine service

Exclusion Criteria

• Heart or lung transplant recipient with concern for graft dysfunction
• Pregnant
• Enrolled in hospice
• Resides in or discharged to a skilled nursing facility/acute rehabilitation facility
• Admitted to a critical care service
• ED deems discharge unsafe due to complex social or medical factors
• Active malignant cancer (per Council of State and Territorial Epidemiologists value set)
• Pulmonary arterial hypertension (per Joint Commission value set)
• Undergoing workup for solid organ transplant
• Interstitial lung disease (including pulmonary fibrosis) (per Higher Level 7 value set)
• Requiring inpatient procedure or surgery defined by the presence of an anesthesia event or operating room encounter.
• The ED deems discharge unsafe due to complex social or medical factors.
• Transferred to an ineligible hospital

Note:

The Health System plans to limit the volume of referrals to the NDC by only referring patients who have an even birth date (this is more equitable than first-come-first-serve, because wage workers are more likely to come to the ED later in the day; even/odd birth date theoretically keeps more spots open for patients presenting to the ED later).

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Days alive and out of hospital (DAOH)	30 days from index ED visit	Cumulative number of days alive and not admitted or boarding in a hospital or emergency department

Secondary Outcome Measures

Name	Time	Method
Global health-related quality of life	30 days from index ED visit	Composite PROMIS-29+2 score (patient reported outcome measurement information system). PROMIS stands for Patient-Reported Outcomes Measurement Information System. High scores mean more of the concept being measured.
Cost effectiveness analysis	Through study completion, an average of 12 months	Total cost per day alive and out of hospital
Patient experience	30 days from index ED visit	Measured by PSQ-18 (patient satisfaction questionnaire). PSQ stands for Patient Satisfaction Questionnaire. High scores indicate higher levels of satisfaction.
Financial analysis	Through study completion, an average of 12 months	Total cost per day of treatment
Hospitalizations avoided	Through study completion, an average of 12 months	Each NDC referral with a preceding Plan to Admit order or Bed Request order (regardless of treatment arm) will be considered an avoided hospitalization, given that the presence of one of these orders establishes that the counterfactual for NDC treatment in hospitalization.
Hospital bed-days saved	Through study completion, an average of 12 months	For each referral to the NDC, the number of hospital bed-days saved will be established by using the mean length of stay for patients treated per-protocol in the control condition matched for the same presenting illness.

Trial Locations

Locations (1)

Ronald Reagan UCLA Medical Center; 🇺🇸 Los Angeles, California, United States