Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
New or worsening symptoms following discharge from the hospital likely leads to unplanned readmission. These rates are higher than desired and costly to patients, payers, and providers. Many interventions have unsuccessfully attempted to reduce readmissions, but few have provided in-home personnel to patients transitioning from acute care back to ambulatory care. Still fewer have involved a physician in the home. We therefore will test the effect of a physician home visit to a patient's home who was discharged in the last 4 days.
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Home visit | Experimental | A participant in this arm will receive a home visit after discharge from the hospital. |
|
| Usual Care | No Intervention | A participant in this arm will not receive a home visit after discharge from the hospital. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Home visit | Other | The visit will be entirely patient tailored, last approximately one hour, and at a minimum will entail:
|
| Measure | Description | Time Frame |
|---|---|---|
| New or worsening symptoms | "Since you got home from the hospital, have you had any symptoms at all?" If no, stop. If yes, continue. "I'm going to read off a list of symptoms, and I want you to tell me if that symptom is new or has gotten worse since you left the hospital. Please don't include symptoms that have stayed the same since you were in the hospital." For each affirmative, double check if the symptom is new or has gotten worse since getting out of the hospital. Only if new or worse, mark yes. | 30 days after discharge from hospital |
| Measure | Description | Time Frame |
|---|---|---|
| Total cost, 30-days post discharge | Day of discharge to 30 days later | |
| Total reimbursement, 30-days post discharge | Day of discharge to 30 days later | |
| 3-item Care Transition Measure, score |
| Measure | Description | Time Frame |
|---|---|---|
| Global satisfaction with care, score | Exploratory | 30 days after discharge |
| Days at home since discharge, # | Exploratory | 30 days after discharge |
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Jeffrey Schnipper, MD MPH | Brigham and Women's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Brigham and Women's Hospital | Boston | Massachusetts | 02115 | United States | ||
| Brigham and Women's Faulkner Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 17431881 | Background | Epstein K, Juarez E, Loya K, Gorman MJ, Singer A. Frequency of new or worsening symptoms in the posthospitalization period. J Hosp Med. 2007 Mar;2(2):58-68. doi: 10.1002/jhm.170. | |
| 19217498 | Background | Boling PA. Care transitions and home health care. Clin Geriatr Med. 2009 Feb;25(1):135-48, viii. doi: 10.1016/j.cger.2008.11.005. |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D006792 | House Calls |
| ID | Term |
|---|---|
| D011364 | Professional Practice |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
|
| 30 days after discharge |
| Primary care provider follow-up within 14 days, y/n | Day of discharge to 14 days later |
| Ability to carry out the discharge plan, score | I would like to ask you about some more problems that you might have faced after you left the hospital one month ago. I will read some statements and ask if you agree or disagree. | 30 days after discharge |
| Change in medication list due to home visit, y/n | Physician-initiated medication change during home visit | Day of home visit |
| Receipt of prescribed medicines following discharge, y/n | Pharmacy confirmation | 30 days after discharge |
| Unplanned 30-day readmission(s) after index hospitalization, y/n | 30 days after discharge |
| Unplanned 30-day readmission(s) after index hospitalization, # | 30 days after discharge |
| All-cause 30-day readmission(s) after index hospitalization, y/n | Exploratory | 30 days after discharge |
| All-cause 30-day readmission(s) after index hospitalization, # | Exploratory | 30 days after discharge |
| Emergency Department (ED) observation stay(s) after index hospitalization, y/n | Exploratory | 30 days after discharge |
| Emergency Department (ED) observation stay(s) after index hospitalization, # | Exploratory | 30 days after discharge |
| Emergency Department (ED) visit(s) after index hospitalization, # | Exploratory | 30 days after discharge |
| Emergency Department (ED) visit(s) after index hospitalization, y/n | Exploratory | 30 days after discharge |
| Imaging, # | Exploratory | 30 days after discharge |
| Imaging, y/n | Exploratory | 30 days after discharge |
| Lab orders, # | Exploratory | 30 days after discharge |
| Lab orders, y/n | Exploratory | 30 days after discharge |
| Physician visits, y/n | Exploratory | 30 days after discharge |
| Physician visits, # | Exploratory | 30 days after discharge |
| Home health utilization, days | Exploratory | 30 days after discharge |
| Home health utilization, y/n | Exploratory | 30 days after discharge |
| All cause 30-day mortality, y/n | Exploratory | 30 days after discharge |
| Unplanned 30-day mortality, y/n | Exploratory | 30 days after discharge |
| Change in medication list due to error at discharge, y/n | Exploratory | Visit date |
| Pneumococcal vaccination if appropriate, y/n | Exploratory | 30 days after discharge |
| Influenza vaccination if appropriate, y/n | Exploratory | 30 days after discharge |
| Smoking cessation counseling if appropriate, y/n | Exploratory | 30 days after discharge |
| Evaluation of ejection fraction as assessed by echocardiogram or other appropriate study, scheduled or completed, if not done within 1 year; y/n | Heart failure patients only; Exploratory; appropriate studies include cardiac magnetic resonance imaging, radionuclide ventriculography, single photon emission computed tomography myocardial perfusion imaging, or left ventriculography | 30 days after discharge |
| Angiotensin converting enzyme inhibitor or angiotensin receptor blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n | Heart failure patients only; Exploratory | 30 days after discharge |
| Beta blocker for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n | Heart failure patients only; Exploratory | 30 days after discharge |
| Aldosterone antagonist for heart failure with reduced ejection fraction (ejection fraction < 40%), y/n | Heart failure patients only; Exploratory | 30 days after discharge |
| Lipid lowering for coronary artery disease, peripheral vascular disease, cerebrovascular accident, or diabetes, y/n | Heart failure patients only; Exploratory | 30 days after discharge |
| Smoking status post-discharge | Heart failure patients only; Exploratory | 30 days after discharge |
| Use of inappropriate medications in the elderly, y/n | Exploratory; using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Beers criteria | 30 days after discharge |
| Time between discharge and visit, days | Exploratory | Date of home visit |
| Duration of physician visit, minutes | Exploratory | Date of home visit |
| Boston |
| Massachusetts |
| 02130 |
| United States |
| 9400040 | Background | Meyer GS, Gibbons RV. House calls to the elderly--a vanishing practice among physicians. N Engl J Med. 1997 Dec 18;337(25):1815-20. doi: 10.1056/NEJM199712183372507. |
| 23978408 | Background | Wong FK, Chow SK, Chan TM, Tam SK. Comparison of effects between home visits with telephone calls and telephone calls only for transitional discharge support: a randomised controlled trial. Age Ageing. 2014 Jan;43(1):91-7. doi: 10.1093/ageing/aft123. Epub 2013 Aug 26. |
| 27631713 | Background | Branowicki PM, Vessey JA, Graham DA, McCabe MA, Clapp AL, Blaine K, O'Neill MR, Gouthro JA, Snydeman CK, Kline NE, Chiang VW, Cannon C, Berry JG. Meta-Analysis of Clinical Trials That Evaluate the Effectiveness of Hospital-Initiated Postdischarge Interventions on Hospital Readmission. J Healthc Qual. 2017 Nov/Dec;39(6):354-366. doi: 10.1097/JHQ.0000000000000057. |
| 19786916 | Background | Wolff JL, Meadow A, Boyd CM, Weiss CO, Leff B. Physician evaluation and management of Medicare home health patients. Med Care. 2009 Nov;47(11):1147-55. doi: 10.1097/MLR.0b013e3181b58e30. |