Reducing Hospital Readmission Among Medical Patients With Depressive Symptoms
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 709
- 试验地点
- 1
- 主要终点
- All-cause readmission rates
研究概览
简要总结
Project Re-Engineered Discharge (Project RED) has previously demonstrated that patients who received the RED were 30% less likely than patients receiving usual care to access inpatient or emergency services within 30 days of discharge. In this project, the investigators add a new dimension to RED by integrating screening, referral and treatment for depression into the original RED intervention and determining if this enhanced intervention increases the effectiveness of RED in preventing readmissions and controlling costs in the 180 days after discharge for patients with signs of depression.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Over 18 years of age
- •Admitted to any Boston Medical Center inpatient service or for observation
- •Screen positive for depressive symptoms (Patient Health Questionnaire - 2 >/= 3)
- •Speaks English with health care providers
- •Has access to a telephone
- •Live in the Boston area and don't plan on leaving the Boston area for more than 2 weeks in the next 6 months
- •Screen positive for depressive symptoms (PHQ -9 >/= 10)
排除标准
- •Has plans for inpatient rehabilitation, nursing home, or other institutional settings after discharge.
- •Suicidal precautions
- •Sickle Cell Crisis (SCC)
- •Alcohol and/or drug dependence
- •Diagnosis of Bipolar Disorder, Schizophrenia or other Psychotic Disorder
- •In police custody
研究组 & 干预措施
RED-D Care Management
Patients randomized to receive the Intervention work with a RED-D Care Manager post-discharge. The Care Manager meets with the patient in the hospital, prior to discharge, and post-discharge via weekly phone calls. Patients have access to a range of treatment options, overseen by the Care Manager, including: (1) medication; (2) cognitive behavioral therapy (CBT); (3) complementary and alternative medicine (CAM) information and referral; (4) Self-help, such as reading a book, making a change in diet and/or exercise in order to improve mood; (5) active surveillance; and (6) any combination of 1, 2, 3, 4 & 5.
干预措施: RED-D Care Management (Other)
RED and Behavioral Health Referral
Patients randomized to the "control" group will receive the regular RED intervention, including a follow-up phone call two days post-discharge from the hospital to review and confirm medications, and a referral to behavioral health.
结局指标
主要结局
All-cause readmission rates
时间窗: 30 days and 90 days post-discharge from hospital at index admission
The primary hypothesis is to test whether the RED intervention plus the collaborative-care approach for depression (RED-D) will reduce the all-cause 30 and 90 day hospital readmission rates for patients who screen positive for depressive symptoms
All-cause reutilization rates
时间窗: 30 & 90 days post discharge from index hospitalization
The primary hypothesis is to test whether the RED intervention plus the collaborative-care approach for depression (RED-D) will reduce the all-cause 30 and 90 day hospital utilization rates for patients who screen positive for depressive symptoms
次要结局
- cost-saving(90 & 180 after discharge from index hospitalization)
- Mental Health Related Quality of Life(30 days and 90 days after discharge from index admission)
研究者
Brian Jack
Professor and Chair
Boston Medical Center