Quasi-Randomized Evaluation of the UCLA Next Day Clinic (NDC)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 570
- 试验地点
- 1
- 主要终点
- Days alive and out of hospital (DAOH)
研究概览
简要总结
The Next Day Clinic (NDC) is a quality improvement initiative that will be launched and operated by UCLA Health starting July 22, 2024. Its goals are to improve patient care and safety and to maximize cost effectiveness. The way it does this is by identifying patients in the ED who would normally be admitted for low-acuity conditions, and diverting them to a high-acuity clinic the following day called the NDC. This will help decompress the ED and the hospital, and allow for overall higher quality care. The Health System has partnered with UCLA's Healthcare Value Analytics and Solutions [UVAS] group which specializes in these types of program evaluations. The analysis conducted by the study team will be used to directly inform NDC operations, scaling, and future plans.
详细描述
NDC is a hospital avoidance model with the potential to simultaneously improve the quality and safety of acute care, reduce costs, and address hospital/ED overcrowding. This novel hospital avoidance program will divert patients from the ED who have been diagnosed with the following conditions and meet certain clinical criteria:
- Diabetic Foot Infection/Osteomyelitis
- Cellulitis
- Congestive Heart Failure
- Syncope
- Pyelonephritis/Urinary Tract Infection
- Pneumonia
- Acute Kidney Infection
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
- •18 years of age or older
- •About to be admitted through the ED for one of the NDC diagnoses or a synonym (per Study Protocol document), defined by the presence of a Plan to Admit order or Bed Request order, OR recently admitted under observation or inpatient status for one of the NDC diagnoses.
- •Identified as at-risk for an avoidable hospitalization in the ED based on a pre-determined set of lab and vital parameters.
- •Insurance that authorizes the patient to follow-up at UCLA Health, or self-pay
- •Admitted or being admitted to an internal medicine service
排除标准
- •Heart or lung transplant recipient with concern for graft dysfunction
- •Enrolled in hospice
- •Admitted to a critical care service
- •ED deems discharge unsafe due to complex social or medical factors
- •Active malignant cancer (per Council of State and Territorial Epidemiologists value set)
- •Pulmonary arterial hypertension (per Joint Commission value set)
- •Undergoing workup for solid organ transplant
- •Interstitial lung disease (including pulmonary fibrosis) (per Higher Level 7 value set)
- •Requiring inpatient procedure or surgery defined by the presence of an anesthesia event or operating room encounter.
- •The ED deems discharge unsafe due to complex social or medical factors.
- •Transferred to an ineligible hospital
- •The Health System plans to limit the volume of referrals to the NDC by only referring patients who have an even birth date (this is more equitable than first-come-first-serve, because wage workers are more likely to come to the ED later in the day; even/odd birth date theoretically keeps more spots open for patients presenting to the ED later).
研究组 & 干预措施
ED-initiated hospitalization
Patients with odd birthdays will be routed to standard-of-care ED-initiated hospitalization pathways.
Next Day Clinic
Patients with even birthdays who meet inclusion criteria will be given the option to receive care in the Next Day Clinic to avoid hospitalization.
干预措施: Next Day Clinic (Other)
结局指标
主要结局
Days alive and out of hospital (DAOH)
时间窗: 30 days from index ED visit
Cumulative number of days alive and not admitted or boarding in a hospital or emergency department
次要结局
- Global health-related quality of life(30 days from index ED visit)
- Cost effectiveness analysis(Through study completion, an average of 12 months)
- Patient experience(30 days from index ED visit)
- Financial analysis(Through study completion, an average of 12 months)
- Hospitalizations avoided(Through study completion, an average of 12 months)
- Hospital bed-days saved(Through study completion, an average of 12 months)
研究者
Richard K. Leuchter, MD
Assistant Professor
University of California, Los Angeles