Evaluation of the impact of a discharge coordinator on continuity of care from hospital to home

Completed

Conditions: Continuity of care from hospital to home
Not Applicable

Registration Number: ISRCTN11113729

Lead Sponsor: Premier's Research Excellence Award (Canada)

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 160

Inclusion Criteria

Participants will be patients who:
1. Will be in hospital for more than 48 hours
2. Who are greater than 65 years of age
3. Who have a diagnosis of acute coronary syndrome, congestive heart failure, pneumonia, exacerbation of chronic obstructive airways disease, falls, or confusion

Participants will also undergo a Short Portable Mental Status Questionnaire and must score above 5 out of 10 questions.

Exclusion Criteria

Patients will be excluded if they score less than 5 on the Short Portable Mental Status Questionnaire, or if they are transferred to another in-patient service at an acute care hospital

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
In this study, the primary outcome will be a composite endpoint to assess the level of discontinuity of care and will include:<br>1. The number of patients admitted with the target conditions who do not complete at least one recommended follow-up test<br>2. The number of patients admitted with the target conditions who do not attend at least one recommended follow-up appointment<br>3. The number of patients admitted with the target conditions who do not fill at least one medication prescribed at discharge

Secondary Outcome Measures

Name	Time	Method
Secondary outcomes include mortality and the proportion of patients readmitted to hospital (including admissions to the Emergency Department). Reasons for readmission will be assessed to determine if a medical error had an impact on readmission. Quality of life will be assessed using the 12-item Short Form health survey (SF-12) and patient satisfaction will be assessed using the Patient Satisfaction Questionnaire which includes items on convenience of care, access to care, continuity of care, competence, explanations of care, degree of consideration shown and overall satisfaction. Outcomes will be assessed at 4, 8, and 12 weeks after the intervention has been implemented.