Skilled Nursing Facility Care at Home: A Randomized Controlled Trial
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Skilled Nursing Facility
- Sponsor
- Brigham and Women's Hospital
- Enrollment
- 300
- Locations
- 5
- Primary Endpoint
- Change in activities of daily living between admission to rehab and discharge from rehab
- Status
- Active, Not Recruiting
- Last Updated
- 6 months ago
Overview
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.
Investigators
David Levine
Associate Physician
Brigham and Women's Hospital
Eligibility Criteria
Inclusion Criteria
- •\>=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)
Exclusion Criteria
- •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
Outcomes
Primary Outcomes
Change in activities of daily living between admission to rehab and discharge from rehab
Time Frame: 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 Outcomes
- Percent time supine per day(Admission to rehab until discharge from rehab, no more than 6 months)
- Total direct medical expenditure(Admission to rehab until discharge from rehab, no more than 6 months)
- Patient experience with care(Admission to rehab until discharge from rehab, no more than 6 months)
- 30-day readmission or 30-day mortality(Discharge from rehab until 30-days later, no more than 30-days)