Community Health Worker and Certified Peer Specialist Intervention to Improve Post-Hospital Outcomes
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Chronic Disease (Physical)
- Sponsor
- University of Illinois at Chicago
- Enrollment
- 55
- Locations
- 1
- Primary Endpoint
- Federal Center for Medicare and Medicaid Services' measure of unplanned readmissions that occur within 30 days of discharge from an initial admission
- Status
- Terminated
- Last Updated
- 3 years ago
Overview
Brief Summary
This study tests an intervention designed to avoid 30-day readmissions following a medical hospitalization by patients who have co-occurring mental illness. The Intervention is delivered by community health workers in the inpatient setting and 30 days following hospital discharge to the community.
Detailed Description
This study will test the efficacy of a brief intervention delivered to adults with co-occurring medical and mental health conditions by community health workers designed to avoid 30-day readmissions following medical hospitalization. Adult inpatients of a university hospital will be randomly assigned to the intervention plus services as usual versus services as usual alone, and assessed at baseline and 30 days following discharge. Chi square will be used to assess the primary outcome of admission within 30 days of discharge and changes in patient activation, mental health symptoms, medication adherence, and perceived competence for health maintenance. Also examined will be study condition differences in post-discharge inpatient service utilization and cost.
Investigators
Judith A. Cook
Professor of Psychiatry
University of Illinois at Chicago
Eligibility Criteria
Inclusion Criteria
- •receiving inpatient treatment for chronic medical condition
- •evidence of a mental health diagnosis
- •age 21- 60 years
- •expected to return to community residence
- •residing within a 30-mile radius of the hospital
- •expected to remain in hospital for 2 or more days
- •able to provide informed consent
Exclusion Criteria
- •terminally ill
- •unable to communicate in English
- •expected to be discharged to skilled facility or nursing home
- •participating in another transitional care intervention
- •hospitalized for behavioral health disorder
Outcomes
Primary Outcomes
Federal Center for Medicare and Medicaid Services' measure of unplanned readmissions that occur within 30 days of discharge from an initial admission
Time Frame: 30 days post discharge
This is a dichotomous indicator variable that reports the occurrence of an inpatient admission to the hospital within 30 days of discharge from a previous hospitalization. Score ranges from 0 (no readmission) to 1 (readmission).
Federal Center for Medicare and Medicaid Services' measure of completion of a outpatient visit with primary care provider
Time Frame: during the 30 days period following discharge
This is a dichotomous indicator variable that reports the completion of a patient's visit to an outpatient primary care provider
Secondary Outcomes
- Perceived Competence for Health Maintenance Questionnaire(study entry (pre-intervention), 30 days post discharge (post intervention))
- Center for Disease Control and Prevention's National Health and Nutrition Examination Survey of Usual Source of Medical Care(study entry (pre-intervention), 30 days post discharge (post intervention))
- Patient Satisfaction Questionnaire(study entry (pre-intervention), 30 days post discharge (post intervention))
- Patient Health Questionnaire-2(study entry (pre-intervention), 30 days post discharge (post intervention))
- Generalized Anxiety Disorder 2-item Questionnaire(study entry (pre-intervention), 30 days post discharge (post intervention))
- Health Care Climate Questionnaire(study entry (pre-intervention), 30 days post discharge (post intervention))
- Patient Activation Measure(study entry (pre-intervention), 30 days post discharge (post intervention))
- Short Form Health Survey(study entry (pre-intervention), 30 days post discharge (post intervention))