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| Name | Class |
|---|---|
| Patient-Centered Outcomes Research Institute | OTHER |
| Society of Hospital Medicine | OTHER |
| COPD Foundation | OTHER |
| University of Kentucky |
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Staying out of the hospital is valued by patients and their caregivers. Their interests converge with those of hospitals now that high 30-day readmission rates for some conditions place hospitals at risk for financial penalties from the Centers for Medicare and Medicaid Services. This study focuses on developing and testing a program that combines a community health worker (lay patient advocate, acting as a "Patient Navigator") and a peer-led telephone support line to improve patient experience during hospital to home transition.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual Care | Other | Hospital usual care Hospital usual care: Written discharge instructions provided to patients prior to hospital discharge. |
|
| Usual Care + PArTNER | Experimental | Navigator intervention: (Community health worker, peer-led telephone support line, usual care) Hospital usual care: Written discharge instructions provided to patients prior to hospital discharge. Community health worker: The community health worker provides social support, literacy appropriate education, and acts as a conduit between the patient and the patient's medical team Peer-led telephone support line: The peer-led telephone support line will provide social support, peer-to-peer coaching, and facilitate communication with the patient's medical care team. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hospital usual care | Behavioral | Written discharge instructions provided to patients prior to hospital discharge. |
|
| Measure | Description | Time Frame |
|---|---|---|
| PROMIS Emotional Distress-Anxiety (v1.0, SF4a) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates improvement. A change equal to 0 indicates no change. A change >0 indicates worsening. | 30 days post discharge |
| PROMIS Informational Support (v2.0, SF4a) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 30 days post discharge |
| Measure | Description | Time Frame |
|---|---|---|
| PROMIS Emotional Support (v2.0, SF4a) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 30 days post discharge |
| PROMIS Instrumental Support (v2.0, SF4a) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jerry A Krishnan, MD, PhD | University of Illinois at Chicago | Principal Investigator |
| Elizabeth Calhoun, PhD | University of Arizona | Principal Investigator |
| Mark V. Williams, MD | University of Kentucky | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Illinois Hospital | Chicago | Illinois | 60612 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35260961 | Derived | LaBedz SL, Prieto-Centurion V, Mutso A, Basu S, Bracken NE, Calhoun EA, DiDomenico RJ, Joo M, Pickard AS, Pittendrigh B, Williams MV, Illendula S, Krishnan JA. Pragmatic Clinical Trial to Improve Patient Experience Among Adults During Transitions from Hospital to Home: the PArTNER study. J Gen Intern Med. 2022 Dec;37(16):4103-4111. doi: 10.1007/s11606-022-07461-0. Epub 2022 Mar 8. |
| Label | URL |
|---|---|
| Patient-Centered Outcomes Research Institute (PCORI): Funding Award details | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | Usual Care | Hospital usual care Hospital usual care: Written discharge instructions provided to patients prior to hospital discharge. |
| FG001 | Usual Care + PArTNER | Navigator intervention: (Community health worker, peer-led telephone support line, usual care) Hospital usual care: Written discharge instructions provided to patients prior to hospital discharge. Community health worker: The community health worker provides social support, literacy appropriate education, and acts as a conduit between the patient and the patient's medical team Peer-led telephone support line: The peer-led telephone support line will provide social support, peer-to-peer coaching, and facilitate communication with the patient's medical care team. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Usual Care | Hospital usual care Hospital usual care: Written discharge instructions provided to patients prior to hospital discharge. |
| BG001 | Usual Care + PArTNER | Navigator intervention: (Community health worker, peer-led telephone support line, usual care) Hospital usual care: Written discharge instructions provided to patients prior to hospital discharge. Community health worker: The community health worker provides social support, literacy appropriate education, and acts as a conduit between the patient and the patient's medical team Peer-led telephone support line: The peer-led telephone support line will provide social support, peer-to-peer coaching, and facilitate communication with the patient's medical care team. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | PROMIS Emotional Distress-Anxiety (v1.0, SF4a) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates improvement. A change equal to 0 indicates no change. A change >0 indicates worsening. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 30 days post discharge |
|
Adverse event data were collected from enrollment through 60 days after hospital discharge.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Usual Care | Hospital usual care Hospital usual care: Written discharge instructions provided to patients prior to hospital discharge. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| All-cause death | General disorders | Non-systematic Assessment | Causes of death were not collected. |
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No limitations or caveats to report.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Jerry A. Krishnan, MD, PhD | University of Illinois at Chicago | 312-413-3291 | partner@uic.edu |
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| ID | Term |
|---|---|
| D029424 | Pulmonary Disease, Chronic Obstructive |
| D006333 | Heart Failure |
| D000755 | Anemia, Sickle Cell |
| D009203 | Myocardial Infarction |
| D011014 | Pneumonia |
| ID | Term |
|---|---|
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002908 | Chronic Disease |
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| OTHER |
| Mended Hearts | UNKNOWN |
| American Heart Association | OTHER |
| Sickle Cell Disease Association of Illinois | UNKNOWN |
| AcademyHealth | OTHER |
| The National Association of Social Workers Foundation | UNKNOWN |
| Respiratory Health Association | UNKNOWN |
| University of Illinois Sickle Cell Patient Council | UNKNOWN |
| National Jewish Health | OTHER |
| Baystate Medical Center | OTHER |
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| Navigator intervention | Behavioral | A Patient Navigator will provide social support, literacy appropriate education, and act as a conduit between the patient and the patient's medical team |
|
| Peer-led telephone support line | Behavioral | The peer-led telephone support line will provide social support, peer-to-peer coaching, and facilitate communication with the patient's medical care team. |
|
Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. |
| 30 days post discharge |
| PROMIS Global Health, Physical (v1.1, SF) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 30 days post discharge |
| PROMIS Global Health, Mental (v1.1, SF) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 30 days post discharge |
| PROMIS Emotional Distress-Anxiety (v1.0, SF4a) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates improvement. A change equal to 0 indicates no change. A change >0 indicates worsening. | 60 days post discharge |
| PROMIS Informational Support (v2.0, SF4a) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 60 days post discharge |
| PROMIS Emotional Support (v2.0, SF4a) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 60 days post discharge |
| PROMIS Instrumental Support (v2.0, SF4a) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 60 days post discharge |
| PROMIS Global Health, Physical (v1.1, SF) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 60 days post discharge |
| PROMIS Global Health, Mental (v1.1, SF) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | 60 days post discharge |
| Death | Caregiver-reported and confirmed by EHR review | 30 days post discharge |
| Death | Caregiver-reported and confirmed by EHR review | 60 days post discharge |
| Re-hospitalization or Death | Confirmed by EHR review | 30 days post discharge |
| Re-hospitalization or Death | Confirmed by EHR review | 60 days post discharge |
| ED Visit, Re-hospitalization, or Death | Confirmed by EHR review | 30 days post discharge |
| ED Visit, Re-hospitalization, or Death | Confirmed by EHR review | 60 days post discharge |
| Outpatient Healthcare Visit | Self-reported | 14 days post discharge |
| Outpatient Healthcare Visit | EHR-reported | 14 days post discharge |
| Withdrawal by Subject |
|
| Other |
|
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
|
|
| Primary | PROMIS Informational Support (v2.0, SF4a) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 30 days post discharge |
|
|
|
| Secondary | PROMIS Emotional Support (v2.0, SF4a) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 30 days post discharge |
|
|
|
| Secondary | PROMIS Instrumental Support (v2.0, SF4a) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 30 days post discharge |
|
|
|
| Secondary | PROMIS Global Health, Physical (v1.1, SF) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 30 days post discharge |
|
|
|
| Secondary | PROMIS Global Health, Mental (v1.1, SF) | Change in T-score from baseline to 30 days post discharge (30 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 30 days post discharge |
|
|
|
| Secondary | PROMIS Emotional Distress-Anxiety (v1.0, SF4a) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates improvement. A change equal to 0 indicates no change. A change >0 indicates worsening. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 60 days post discharge |
|
|
|
| Secondary | PROMIS Informational Support (v2.0, SF4a) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 60 days post discharge |
|
|
|
| Secondary | PROMIS Emotional Support (v2.0, SF4a) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 60 days post discharge |
|
|
|
| Secondary | PROMIS Instrumental Support (v2.0, SF4a) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 60 days post discharge |
|
|
|
| Secondary | PROMIS Global Health, Physical (v1.1, SF) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 60 days post discharge |
|
|
|
| Secondary | PROMIS Global Health, Mental (v1.1, SF) | Change in T-score from baseline to 60 days post discharge (60 days minus baseline). A change in t-score <0 indicates worsening. A change equal to 0 indicates no change. A change >0 indicates improvement. | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Mean | Standard Error | T-score | 60 days post discharge |
|
|
|
| Secondary | Death | Caregiver-reported and confirmed by EHR review | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Count of Participants | Participants | 30 days post discharge |
|
|
|
| Secondary | Death | Caregiver-reported and confirmed by EHR review | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Count of Participants | Participants | 60 days post discharge |
|
|
|
| Secondary | Re-hospitalization or Death | Confirmed by EHR review | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Count of Participants | Participants | 30 days post discharge |
|
|
|
| Secondary | Re-hospitalization or Death | Confirmed by EHR review | Posted | Count of Participants | Participants | 60 days post discharge |
|
|
|
| Secondary | ED Visit, Re-hospitalization, or Death | Confirmed by EHR review | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Count of Participants | Participants | 30 days post discharge |
|
|
|
| Secondary | ED Visit, Re-hospitalization, or Death | Confirmed by EHR review | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Count of Participants | Participants | 60 days post discharge |
|
|
|
| Secondary | Outpatient Healthcare Visit | Self-reported | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Count of Participants | Participants | 14 days post discharge |
|
|
|
| Secondary | Outpatient Healthcare Visit | EHR-reported | Due to missing data, the number of participants analyzed may be less than the numbers provided in the Participant Flow module. | Posted | Count of Participants | Participants | 14 days post discharge |
|
|
|
| 12 |
| 511 |
| 12 |
| 511 |
| 0 |
| 511 |
| EG001 | Usual Care + PArTNER | Navigator intervention: (Community health worker, peer-led telephone support line, usual care) Hospital usual care: Written discharge instructions provided to patients prior to hospital discharge. Community health worker: The community health worker provides social support, literacy appropriate education, and acts as a conduit between the patient and the patient's medical team Peer-led telephone support line: The peer-led telephone support line will provide social support, peer-to-peer coaching, and facilitate communication with the patient's medical care team. | 12 | 518 | 12 | 518 | 0 | 518 |
|
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| D020969 |
| Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D000745 | Anemia, Hemolytic, Congenital |
| D000743 | Anemia, Hemolytic |
| D000740 | Anemia |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D006453 | Hemoglobinopathies |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D017202 | Myocardial Ischemia |
| D014652 | Vascular Diseases |
| D007238 | Infarction |
| D007511 | Ischemia |
| D009336 | Necrosis |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |