The Impact of a Patient-Centered Discharge Summary (PODS) on Patient Experience and Health Outcomes Following Discharge: A Multicenter Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 581
- 试验地点
- 2
- 主要终点
- Patient experience of transition of care
研究概览
简要总结
Improving the patient experience has become a major focus of quality improvement efforts in Ontario and in health systems worldwide. However, our existing knowledge base is relatively under-developed, particularly in how patients experience care as they transition from one care setting to another and the relationship between patient experience and clinical outcomes. The Patient Oriented Discharge Summary (PODS) is a discharge instruction tool created by patients, caregivers, health-care providers and design experts. It provides a written template for providers to engage patients and caregivers when reviewing important instructions on medications, activity and diet restrictions, follow-up appointments and worrisome symptoms warranting emergency care following admission to hospital. The PODS also uses plain and simple wording, large fonts, pictograms, and includes white space for patients to take notes and provides the option for translation of major headings into the most common spoken languages. The PODS impact study will study the impact of using the PODS versus usual discharge instructions on patient experience and health outcomes in a provincial-wide randomized study across acute care and rehabilitation hospitals.
详细描述
Full Title: The impact of a patient-centered discharge summary (PODS) on patient experience and health outcomes following discharge: A multicenter randomized controlled trial.
Short Title: PODS Impact Study
Primary Objective: To evaluate the impact of a patient-centered discharge instruction tool on patient experience following hospital discharge.
Primary Outcome Measure: Patient experience within 72 hours following discharge from hospital. Count of negative responses (i.e., "No", or "Not at all" or "Partly") to 6 prespecified questions on patient experience of transition of care answered 72 hours following discharge from hospital, with the first 5 questions from the CIHI Patient Experiences Survey - In-Patient Care (CPES-IC). Groups will be compared using a rate ratio (ratio of negative binomial rates).
Secondary Objectives: 1) Evaluate the impact of a patient-centered discharge instruction tool on health outcomes following hospital discharge. 2) Identify the level of patient and system engagement needed when providing discharge instructions and patient-specific characteristics that might impact the use and effectiveness of discharge instructions.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
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 or over
- •Able and willing to provide informed consent or have a substitute decision maker that can provide consent and agree to answer follow up as the patient's caregiver
- •Admitted to hospital with either congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), Stroke, Pneumonia, Hip Fracture, Knee Replacement or Hip Replacement
- •Being discharged home or to a retirement home
- •Have a Telephone for post-discharge follow-up
排除标准
- •Patients who have already received the PODS in the past
- •Being discharged to nursing home, long-term care facility, rehabilitation or other hospital.
- •Unable to communicate due to cognitive impairment or language barrier with no caregiver or interpreter available
- •Palliative patient with life expectancy <= 3 months
研究组 & 干预措施
PODS intervention
The PODS intervention is administered during the discharge process which includes discharge teaching. In the acute settings, discharge teaching is provided by a nurse navigator, resident physician, or other members of the care team. In the rehabilitation setting, discharge teaching is provided by a multi-disciplinary team. PODS is used as a useful add-on to the usual discharge teaching process. The PODS form used during the study will be a fillable pdf. Members of the healthcare team will fill it out electronically, then print it out and give the paper to the patient. After the discharge teaching is finished, patients take the completed PODS home with them as a post-discharge reference and guide.
干预措施: Patient Oriented Discharge Summary (Other)
Usual Care
Patients randomized to this arm will receive usual discharge care. At UHN, this involves receiving a discharge summary with information pertaining to hospital course including investigations performed and medications used, as well as follow-up care suggested. It is intended to be, unlike PODS, a document for the primary care physician seeing the patient after discharge to refer to. As to discharge instructions provided for the patient, there is no standard procedure and sometimes follow-up instructions are included for the patient. Patient education may or may not be provided to the patient verbally by their nurse, resident, physician, or pharmacist. Moreover, follow-up with the primary care physician may be set up prior to or following discharge with the nurse navigator.
结局指标
主要结局
Patient experience of transition of care
时间窗: 72 hours post-discharge
Count of negative responses to 6 questions, with first 5 from CIHI CPES-IC: 1.During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital? 2.During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital? 3.Before you left the hospital, did you have a clear understanding about all of your prescribed medications, including those you were taking before your hospital stay? 4.Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital? 5.When you left the hospital, did you have a better understanding of your condition than when you entered? 6.When you left the hospital, did you have a clear understanding about your follow-up appointments and investigations? Analysis change via DMC recommendation.
次要结局
- activity adherence(30 and 90 days)
- medication adherence(30 and 90 days)
- diet adherence(30 and 90 days)
- unscheduled utilization(30 and 90 days)
- appointment adherence(30 and 90 days)
- Patient experience measure [original primary outcome measure](72 hours post-discharge)