Skilled Nursing Facility Care At Home
- Conditions
- Skilled Nursing FacilityRehabilitation
- Interventions
- Other: Skilled nursing facility care at home
- Registration Number
- NCT06416670
- Lead Sponsor
- Brigham and Women's Hospital
- Brief Summary
We will perform a parallel-group multicenter patient-level randomized controlled evaluation of skilled nursing facility care at home. Patients typically referred to a skilled nursing facility following hospitalization will be eligible for enrollment. Instead of admission to a skilled nursing facility, participants will receive care from a technology-enabled team in their own homes or will be allocated to receive care in a traditional skilled nursing facility setting.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 300
- >=18 years old
- Requires SNF PAC care following hospitalization, as determined by the inpatient team (requires documented rehabilitative therapy recommendation)
- Community-dwelling before hospitalization
- Likely to return to community-dwelling status following short-term rehabilitation as determined by RAH liaison
- Lives within 10 miles of any study site hospital (or per specified catchment)
- Surgical trauma and elective patients (weight bearing as tolerated and transfer with no more than one-person assist)
- Neurology patients - Stroke (needs acute rehabilitation, but insurance will not cover, so bound for SNF. Does not meet acute rehabilitation criteria and does not need long-term placement)
-
Environmental
- Undomiciled
- No working heat (October-April), no working air conditioning if forecast > 80°F, or no running water
- In police custody
- Resides in a facility that does not allow advanced on-site care
- Domestic violence screen positive
- Weapons that cannot be appropriately secured
- Difficulty accessing the bathroom (unless there is space for a bedside commode where the patient sleeps or if the patient is entirely dependent on toileting)
- Home has insufficient accessible space to sleep, eat, and perform rehabilitative therapy
- Home lacks sufficient kitchen facilities to either cook or heat meals
- Patient, or patient's family caregiver, unable to communicate via telephone
- Patient, or patient's family caregiver, lacks consistent access to a telephone
-
Clinical
- Requires more than one assist (unless the family can provide additional 24/7 assistance)
- Requires care of new ostomy or teaching ostomy care
- Requires frequent suctioning, tracheostomy, and ventilator needs
- Requires total parenteral nutrition
- Requires nasogastric tube feeds
- Requires durable medical equipment not already in place at home and excluded below
- Requires daily subcutaneous injection unless patient or family caregiver is teachable and able to administer daily
- Acute delirium noted by RAH liaison requiring more than one caregiver
- Active psychiatric diagnosis without an adequate treatment plan
- On methadone requiring daily pickup of medication
- Requires administration of intravenous controlled substances
- Requires administration of specialty medications not already in place at home
- Requires transfusion of blood products
- Requires three times weekly or more transfers back and forth to obtain specialty medical care
- Requires hemodialysis
- Orthopedic trauma and elective patients
- Traumatic brain injury
- Wound or appliance care that requires daily nursing care
- For spine trauma: neurologic deficits requiring more than one assist
-
Neurology patients
- PRESS score (for ischemic stroke; use PRESS app): no return to pre-stroke diet > 50%
- FUNC score (for primary intracerebral hemorrhage only): <75% probability of functional independence at 90 days
- ASTRAL score (for ischemic stroke only and patients with pre-stroke independence [Modified Rankin Scale 0-2]): <75% probability of a 90-day poor functional outcome (Modified Rankin Scale result of 3-6)
-
RAH census is full
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Rehab at home Skilled nursing facility care at home Intervention subjects will receive care in their home from a specialized care team.
- Primary Outcome Measures
Name Time Method Change in activities of daily living between admission to rehab and discharge from rehab Admission to rehab until discharge from rehab, no more than 6 months Subtract the patient's activities of daily living at discharge from rehab from the patient's activities of daily living on admission to rehab.
- Secondary Outcome Measures
Name Time Method Percent time supine per day Admission to rehab until discharge from rehab, no more than 6 months The percentage of time a patient is supine per day, as measured by their wrist-worn accelerometer.
Total direct medical expenditure Admission to rehab until discharge from rehab, no more than 6 months The percent difference in direct cost of care to deliver rehab care.
Patient experience with care Admission to rehab until discharge from rehab, no more than 6 months The Picker patient experience questionaire-15
30-day readmission or 30-day mortality Discharge from rehab until 30-days later, no more than 30-days The percentage of patients who are readmitted or deceased within 30-days of discharge from rehab.
Trial Locations
- Locations (5)
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
Cambridge Health Alliance
🇺🇸Cambridge, Massachusetts, United States
Massachusetts General Hospital
🇺🇸Boston, Massachusetts, United States
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
Brigham and Women's Faulkner Hospital
🇺🇸Boston, Massachusetts, United States