Comparison Between Two Strategies of Discharge Planning for the Reduction of Short Term Hospital Readmissions

Not Applicable

Completed

• Conditions: Patient Discharge
• Interventions: Other: Routine Discharge Planning (RDP); Other: On Demand Discharge Planning (DDP)

• Registration Number: NCT03436940
• Lead Sponsor: A.O.U. Città della Salute e della Scienza

Brief Summary

The purpose of this study is to improve discharge planning effectiveness by comparing two strategies \[on-Demand Discharge Planning (DDP) vs. Routine Discharge Planning (RDP)\], in terms of reduction of hospital readmissions for inpatients classified at intermediate risk of complex discharge using the simplified Blaylock Risk Assessment Screening Score (BRASS).

Detailed Description

The purpose of this study is to improve discharge planning effectiveness by comparing two strategies \[on-Demand Discharge Planning (DDP) vs. Routine Discharge Planning (RDP)\], in terms of reduction of hospital readmissions for inpatients classified at intermediate risk of complex discharge using the simplified Blaylock Risk Assessment Screening Score (BRASS).

Five Internal Medicine Unit and four Units of Neurology will be randomized to the two different strategies of discharge planning (RDP or DDP), based on two different alternating sequences of four periods (each period comprising three months). The randomization will be stratified by type of unit.

Patients at risk of complex discharge, according to the simplified BRASS score, are assigned to the Hospital Unit of Continuity of Care (NOCC) team, using the hospital telematics system. Afterwards, the NOCC team proposes an appropriate discharge planning, considering clinical and social needs.

Study Timeline

• Study First Submitted: 2018-02-13
• Study First Submitted QC: 2018-02-16
• Study First Posted: 2018-02-19
• Study Start: 2018-06-01
• Primary Completion: 2019-10-12
• Study Completion: 2019-10-13
• Status Verified: 2022-03
• Last Update Submitted: 2022-03-15
• Last Update Posted: 2022-03-29

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 802

Inclusion Criteria

• Adults patients (age ≥ 18 years);
• Residents in Piedmont, Italy;
• Patients admitted to General Internal Medicine or Neurology Units of Molinette Hospital (Turin)
• Patients with a score in the simplified BRASS between 4 and 6 at admission

No specific exclusion criteria were applied.

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Routine Discharge Planning (RDP)	Routine Discharge Planning (RDP)	All patients with an intermediate threshold value of the simplified Blaylock Risk Assessment Screening Score are submitted to discharge planning by the NOCC team (Hospital Unit of Continuity of Care)
On Demand Discharge Planning (DDP)	On Demand Discharge Planning (DDP)	Patients with an intermediate score, according to the simplified Blaylock Risk Assessment Screening Score, are addressed to the NOCC team only in case of a specific request by the unit of hospitalization.

Primary Outcome Measures

Name	Time	Method
Unexpected hospital readmission within 90 days from discharge	90 days	Proportion of hospital admissions in the standard admission regime within 90 days from the date of discharge. The endpoint will be calculated only for patients discharged alive. Readmissions for any cause under ordinary admissions will be considered as event. The Day Hospital re-admissions will not be considered for the endpoint calculation.

Secondary Outcome Measures

Name	Time	Method
Death within 90 days from discharge	90 days	Proportion of deaths within 90 days of discharge date. The endpoint will be calculated only for patients discharged alive. Death for any cause will be considered as event.
Proportion of Long Length of Stay (LLOS)	150 days	Proportion of admissions with long duration of hospitalization (LLOS - Long Length of Stay). The endpoint will be calculated for all hospitalized patients. An admission will be considered as LLOS if its duration will be higher than the 90th specific percentile for Diagnostic Related Group (DRG ) detected at the regional level in Piedmont in 2016.
Healthcare costs until 90 days from the discharge	90 days	Health care costs charged to the National Health Service (NHS) between the date of admission and 90 days from the date of discharge or death of the patient.
Proportion of patients reported to the NOCC team during the DDP-experimental phase	150 days	Incidence of activations of the NOCC in the periods of adoption of the DDP strategy (only for admissions treated with DDP strategy)

Trial Locations

Locations (1)

AOU Città della Salute; 🇮🇹 Torino, Italy