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| ID | Type | Description | Link |
|---|---|---|---|
| R01NR017636 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute of Nursing Research (NINR) | NIH |
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This study will test whether transitional care targeting care needs of seriously ill, skilled nursing facility (SNF) patients and their caregivers will help to improve SNF patient outcomes (preparedness for discharge, quality of life, function and acute care use) and caregiver outcomes (preparedness for the caregiving role. caregiver burden and caregiver distress).
Prior research has not established an evidence-based model of transitional care for seriously ill SNF patients (and their caregivers) who transfer from SNF to home-based care. Connect-Home, the intervention to be tested in this study, will use existing nursing home staff and community-based nurses to deliver transitional care in SNFs and the patient's home.
The feasibility, acceptability, and estimated efficacy of Connect-Home was demonstrated in a pilot test of pre-discharge elements of Connect-Home (N=133 patients and their caregivers). Compared to controls, intervention participants were significantly more prepared for discharge (higher scores on Care Transitions Measure-15) and they more frequently received individualized plans for continuing care at home. Virtually all SNF staff participants (97%) recommended the intervention for future use, demonstrating its acceptability. The objective of this study is to test the efficacy of Connect-Home for seriously ill patients discharged to home and their caregivers.
In this trial, intervention participants will receive the Connect-Home intervention; the intervention has two steps. While the patient is in the SNF, nurses, social workers and rehabilitation therapists will create an individualized Transition Plan of Care and prepare the patient and caregiver to manage the patient's serious illness at home. Within 24 hours of the time that the SNF patient discharges to home, a Connect-Home Activation Nurse (Activation RN) will visit the patient at home; the Activation RN will help the patient and family caregiver implement the written Transition Plan of Care. The Connect-Home intervention will focus on six key care needs: (1) home safety and level of assistance; (2) advance care planning; (3) symptom management; (4) medication reconciliation; (5) function and activity; and (6) coordination of follow-up medical care. In this trial, the control participants will receive usual discharge planning in the SNF only. Usual discharge planning for SNF patients includes assignment to an interdisciplinary team that develops discharge instructions for the patient to follow at home with oversight by a physician. Usual care does not include a structured home visit after the patient discharges to home.
Patient and caregiver outcomes will assessed in 7, 30, and 60 days after the patient discharged from the SNF to home. Outcomes assessors will be blinded to study group.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Connect-Home | Experimental | Connect-Home intervention at the skilled nursing facility and at the subject's home. |
|
| Control | No Intervention | Standard discharge planning at the skilled nursing facility only. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Connect-Home | Behavioral | Connect-Home will introduce organizational structure to support delivery of transitional care processes. New elements of structure include:electronic health record (EHR) template, Connect-Home Toolkit, and Staff Training. After structural elements are added, SNF staff will use Connect-Home care processes to deliver the 2-step transitional care intervention.In Step 1, SNF nurses, therapists, and social workers will develop a Transition Plan of Care and prepare the patient and caregiver to manage the patient's serious illness and functional needs. In Step 2, the Connect-Home Activation RN will visit the patient's home within 24 hours of discharge; the nurse will activate the Transition Plan of Care at home. Both intervention steps focus on 6 key care needs to optimize patient and caregiver outcomes: 1) home safety and level of assistance; 2) advance care planning; 3) symptom management; 4) medication reconciliation; 5) function and activity; and 6) coordination of follow-up medical care. |
| Measure | Description | Time Frame |
|---|---|---|
| Care Transitions Measure-15 Score 7 Days After Skilled Nursing Facility Discharge | The patient's preparedness for discharge will be measured by the Care Transitions Measure-15 (CTM-15), which includes 5 items on a 4-point scale. The CTM-15 measures self-reported knowledge and skills for continuing care at home. Summary score range 0-100, with higher scores associated with less acute care use after discharge. | 7 Days After SNF Discharge |
| Preparedness for Caregiving Scale Score 7 Days After Patient's Skill Nursing Facility Discharge | The caregiver's preparedness for caregiving will be measured by the Preparedness for Caregiving Scale (PCS), which includes 8 items on a five-point Likert scale (0-4). The PCS measures self-reported readiness for caregiving. Range = 0-32, with higher scores associated with less anxiety. | 7 Days After Patient SNF Discharge |
| Measure | Description | Time Frame |
|---|---|---|
| McGill Quality of Life Questionnaire-Revised Score 30 Days After Skilled Nursing Facility Discharge | The patient's quality of life will be measured using the McGill Quality of Life Questionnaire-Revised (MQoL-R), which includes 14 items on a ten-point Likert scale. The scale is recommended for studies of palliative care and measures quality of life across disease trajectories. Range = 0-10, with higher score indicating better quality of life. There are 4 MQOL-R subscales. Each subscale score is the mean of its items that range from 0-10. The Total Score, also ranging from 0-10, is the mean of the subscale score means. |
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Inclusion Criteria for patients:
Inclusion Criteria for Caregivers:
Exclusion Criteria for Patients:
There are no exclusion criteria for Caregivers.
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| Name | Affiliation | Role |
|---|---|---|
| Mark Toles, PhD, RN | University of North Carolina, Chapel Hill | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UNC-Chapel Hill | Chapel Hill | North Carolina | 27599 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33546737 | Derived | Toles M, Colon-Emeric C, Hanson LC, Naylor M, Weinberger M, Covington J, Preisser JS. Transitional care from skilled nursing facilities to home: study protocol for a stepped wedge cluster randomized trial. Trials. 2021 Feb 5;22(1):120. doi: 10.1186/s13063-021-05068-0. |
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Deidentified individual data that supports the results will be shared beginning 9 to 36 months following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.
9 to 36 months following publication.
Investigators who propose to use the data must have approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and must execute a data use/sharing agreement with UNC.
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| ID | Title | Description |
|---|---|---|
| FG000 | SNF 1 | Connect-Home intervention at skilled nursing facility (SNF) 1. Participants at this SNF enter the Standard of Care phase for 5 months, the Pre-Implementation phase for 2 months and the Connect-Home phase for 11 months. Participants will encounter discharge planning at the skilled nursing facility and will have data collected at 7, 30, and 60 days post SNF discharge. |
| FG001 | SNF 2 | Connect-Home intervention at skilled nursing facility (SNF) 2. Participants at this SNF enter the Standard of Care phase for 6 months, the Pre-Implementation phase for 2 months and the Connect-Home phase for 10 months. Participants will encounter discharge planning at the skilled nursing facility and will have data collected at 7, 30, and 60 days post SNF discharge. |
| FG002 | SNF 3 | Connect-Home intervention at skilled nursing facility (SNF) 3. Participants at this SNF enter the Standard of Care phase for 7 months, the Pre-Implementation phase for 2 months and the Connect-Home phase for 9 months. Participants will encounter discharge planning at the skilled nursing facility and will have data collected at 7, 30, and 60 days post SNF discharge. |
| FG003 | SNF 4 | Connect-Home intervention at skilled nursing facility (SNF) 4. Participants at this SNF enter the Standard of Care phase for 8 months, the Pre-Implementation phase for 2 months and the Connect-Home phase for 8 months. Participants will encounter discharge planning at the skilled nursing facility and will have data collected at 7, 30, and 60 days post SNF discharge. |
| FG004 | SNF 5 | Connect-Home intervention at skilled nursing facility (SNF) 5. Participants at this SNF enter the Standard of Care phase for 9 months, the Pre-Implementation phase for 2 months and the Connect-Home phase for 7 months. Participants will encounter discharge planning at the skilled nursing facility and will have data collected at 7, 30, and 60 days post SNF discharge. |
| FG005 | SNF 6 | Connect-Home intervention at skilled nursing facility (SNF) 6. Participants at this SNF enter the Standard of Care phase for 10 months, the Pre-Implementation phase for 2 months and the Connect-Home phase for 6 months. Participants will encounter discharge planning at the skilled nursing facility and will have data collected at 7, 30, and 60 days post SNF discharge. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Standard of Care (5-10 Months) |
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| Pre-Implementation Phase (2 Months) |
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| Connect-Home (5-10 Months) |
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| ID | Title | Description |
|---|---|---|
| BG000 | Connect-Home Patients | Connect-Home intervention at the skilled nursing facility and at the subject's home. Participants will have data collected at 7, 30, and 60 days post SNF discharge. |
| BG001 | Connect-Home Caregivers |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| 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 | Care Transitions Measure-15 Score 7 Days After Skilled Nursing Facility Discharge | The patient's preparedness for discharge will be measured by the Care Transitions Measure-15 (CTM-15), which includes 5 items on a 4-point scale. The CTM-15 measures self-reported knowledge and skills for continuing care at home. Summary score range 0-100, with higher scores associated with less acute care use after discharge. | Data reported for participants who answered the 7-day data collection phone call. | Posted | Mean | Standard Deviation | score on a scale | 7 Days After SNF Discharge |
|
Adverse events were collected from when participants entered the study to when they completed study procedures, an approximate total of up to 90 days.
Due to the severity of illness present in the study population, unrelated adverse events were expected during this study.
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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 | Connect-Home Patients | Connect-Home intervention at the skilled nursing facility and at the subject's home. Participants will have data collected at 7, 30, and 60 days post SNF discharge. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hospitalization for generalized weakness | General disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Mark Toles, MPH | University of North Carolina at Chapel Hill | 919-966-5684 | mtoles@email.unc.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jul 13, 2020 | May 17, 2022 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jan 30, 2019 | May 2, 2022 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D000073496 | Frailty |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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The Connect-Home study employs a stepped wedge cluster-randomized trial design, which is a crossover design at the cluster level where clusters of individuals (i.e., residents in a nursing home) crossover from control to intervention condition at randomly assigned timepoints or steps.
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|
| 30 Days After SNF Discharge |
| McGill Quality of Life Questionnaire-Revised Score 60 Days After Skilled Nursing Facility Discharge | The patient's quality of life will be measured using the McGill Quality of Life Questionnaire-Revised (MQoL-R), which includes 14 items on a ten-point Likert scale. The scale is recommended for studies of palliative care and measures quality of life across disease trajectories. Range = 0-10, with higher score indicating better quality of life. There are 4 MQOL-R subscales. Each subscale score is the mean of its items that range from 0-10. The Total Score, also ranging from 0-10, is the mean of the subscale score means. | 60 Days After SNF Discharge |
| Life Space Assessment 30 Days After Skilled Nursing Facility Discharge | Patient's function will be measured using the Life Space Assessment, which includes 5 Likert scales corresponding to a hierarchy of levels of mobility (each scored from 0-4) where weights are the product of the "Life-space level" (range 1-5) and the "independence" score (range 1-2). The range is 1-120. Lower scores are associated with falls and hospitalization. | 30 Days After SNF Discharge |
| Life Space Assessment 60 Days After Skilled Nursing Facility Discharge | Patient's function will be measured using the Life Space Assessment, which includes 5 Likert scales corresponding to a hierarchy of levels of mobility (each scored from 0-4) where weights are the product of the "Life-space level" (range 1-5) and the "independence" score (range 1-2). The range is 1-120. Lower scores are associated with falls and hospitalization. | 60 Days After SNF Discharge |
| Zarit Caregiver Burden Scale 30 Days After Skilled Nursing Facility Discharge | Caregiver burden will be measured using the Zarit Caregiver Burden Scale, which includes 12 items on a five-point scale, measuring caregiver perceptions that "caregiving has an adverse effect on their emotional, social, financial, physical and spiritual functioning." Scores range 0-48; higher scores are associated with depression and social isolation. | 30 Days After Patient's SNF Discharge |
| Zarit Caregiver Burden Scale 60 Days After Skilled Nursing Facility Discharge | Caregiver burden will be measured using the Zarit Caregiver Burden Scale, which includes 12 items on a five-point scale, measuring caregiver perceptions that "caregiving has an adverse effect on their emotional, social, financial, physical and spiritual functioning." Scores range 0-48; higher scores are associated with depression and social isolation. | 60 Days After Patient's SNF Discharge |
| Distress Thermometer 30 Days After Skilled Nursing Facility Discharge | Caregiver distress will be measured using the Distress Thermometer, which includes 1 item on an 11-point scale, measuring negative affect (e.g., sadness and fear) related to caregiving for a severely ill person. Score ranges 0-10, with scores >4 associated with poor coping and depression. | 30 Days After Patient's SNF Discharge |
| Distress Thermometer 60 Days After Skilled Nursing Facility Discharge | Caregiver distress will be measured using the Distress Thermometer, which includes 1 item on an 11-point scale, measuring negative affect (e.g., sadness and fear) related to caregiving for a severely ill person. Score ranges 0-10, with scores >4 associated with poor coping and depression. | 60 Days After Patient's SNF Discharge |
| Self-Reported Days of ED or Hospital Use 30 Days After Skilled Nursing Facility Discharge | Patient's days of acute care use will be measured using the self-reported number of combined number of days the patient spends in the Emergency Department (ED) or hospital in 30 days after SNF discharge. | 30 Days After SNF Discharge |
| Self-Reported Days of ED or Hospital Use 60 Days After Skilled Nursing Facility Discharge | Patient's days of acute care use will be measured using the self-reported number of combined number of days the patient spends in the ED or hospital in 60 days after SNF discharge. | 60 Days After SNF Discharge |
| Patients Started |
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| Caregivers Started |
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| Completed 7-Day (Patients) |
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| Completed 7-Day (Caregivers) |
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| Completed 30-Day (Patients) |
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| Completed 30-Day (Caregivers) |
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| Completed 60-Day (Patients) |
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| Completed 60-Day (Caregivers) |
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| COMPLETED |
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| NOT COMPLETED |
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| Patients Started |
|
| Caregivers Started |
|
| Completed 7-Day (Patients) |
|
| Completed 7-Day (Caregivers) |
|
| Completed 30-Day (Patients) |
|
| Completed 30-Day (Caregivers) |
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| Completed 60-Day (Patients) |
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| Completed 60-Day (Caregivers) |
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| COMPLETED |
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| NOT COMPLETED |
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Caregivers of Connect-Home study patients.
| BG002 | Control Patients | Standard discharge planning at the skilled nursing facility only. Participants will have data collected at 7, 30, and 60 days post SNF discharge. |
| BG003 | Control Caregivers | Caregivers of Control study patients. |
| BG004 | Total | Total of all reporting groups |
| Years |
|
| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Count of Participants | Participants |
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| Control |
Standard discharge planning at the skilled nursing facility only. Participants will have data collected at 7, 30, and 60 days post SNF discharge |
|
|
|
| Primary | Preparedness for Caregiving Scale Score 7 Days After Patient's Skill Nursing Facility Discharge | The caregiver's preparedness for caregiving will be measured by the Preparedness for Caregiving Scale (PCS), which includes 8 items on a five-point Likert scale (0-4). The PCS measures self-reported readiness for caregiving. Range = 0-32, with higher scores associated with less anxiety. | Posted | Mean | Standard Deviation | score on a scale | 7 Days After Patient SNF Discharge |
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| Secondary | McGill Quality of Life Questionnaire-Revised Score 30 Days After Skilled Nursing Facility Discharge | The patient's quality of life will be measured using the McGill Quality of Life Questionnaire-Revised (MQoL-R), which includes 14 items on a ten-point Likert scale. The scale is recommended for studies of palliative care and measures quality of life across disease trajectories. Range = 0-10, with higher score indicating better quality of life. There are 4 MQOL-R subscales. Each subscale score is the mean of its items that range from 0-10. The Total Score, also ranging from 0-10, is the mean of the subscale score means. | Posted | Mean | Standard Deviation | score on a scale | 30 Days After SNF Discharge |
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|
|
|
| Secondary | McGill Quality of Life Questionnaire-Revised Score 60 Days After Skilled Nursing Facility Discharge | The patient's quality of life will be measured using the McGill Quality of Life Questionnaire-Revised (MQoL-R), which includes 14 items on a ten-point Likert scale. The scale is recommended for studies of palliative care and measures quality of life across disease trajectories. Range = 0-10, with higher score indicating better quality of life. There are 4 MQOL-R subscales. Each subscale score is the mean of its items that range from 0-10. The Total Score, also ranging from 0-10, is the mean of the subscale score means. | Posted | Mean | Standard Deviation | score on a scale | 60 Days After SNF Discharge |
|
|
|
|
| Secondary | Life Space Assessment 30 Days After Skilled Nursing Facility Discharge | Patient's function will be measured using the Life Space Assessment, which includes 5 Likert scales corresponding to a hierarchy of levels of mobility (each scored from 0-4) where weights are the product of the "Life-space level" (range 1-5) and the "independence" score (range 1-2). The range is 1-120. Lower scores are associated with falls and hospitalization. | Posted | Mean | Standard Deviation | score on a scale | 30 Days After SNF Discharge |
|
|
|
|
| Secondary | Life Space Assessment 60 Days After Skilled Nursing Facility Discharge | Patient's function will be measured using the Life Space Assessment, which includes 5 Likert scales corresponding to a hierarchy of levels of mobility (each scored from 0-4) where weights are the product of the "Life-space level" (range 1-5) and the "independence" score (range 1-2). The range is 1-120. Lower scores are associated with falls and hospitalization. | Posted | Mean | Standard Deviation | score on a scale | 60 Days After SNF Discharge |
|
|
|
|
| Secondary | Zarit Caregiver Burden Scale 30 Days After Skilled Nursing Facility Discharge | Caregiver burden will be measured using the Zarit Caregiver Burden Scale, which includes 12 items on a five-point scale, measuring caregiver perceptions that "caregiving has an adverse effect on their emotional, social, financial, physical and spiritual functioning." Scores range 0-48; higher scores are associated with depression and social isolation. | Posted | Mean | Standard Deviation | score on a scale | 30 Days After Patient's SNF Discharge |
|
|
|
|
| Secondary | Zarit Caregiver Burden Scale 60 Days After Skilled Nursing Facility Discharge | Caregiver burden will be measured using the Zarit Caregiver Burden Scale, which includes 12 items on a five-point scale, measuring caregiver perceptions that "caregiving has an adverse effect on their emotional, social, financial, physical and spiritual functioning." Scores range 0-48; higher scores are associated with depression and social isolation. | Posted | Mean | Standard Deviation | score on a scale | 60 Days After Patient's SNF Discharge |
|
|
|
|
| Secondary | Distress Thermometer 30 Days After Skilled Nursing Facility Discharge | Caregiver distress will be measured using the Distress Thermometer, which includes 1 item on an 11-point scale, measuring negative affect (e.g., sadness and fear) related to caregiving for a severely ill person. Score ranges 0-10, with scores >4 associated with poor coping and depression. | Posted | Mean | Standard Deviation | score on a scale | 30 Days After Patient's SNF Discharge |
|
|
|
|
| Secondary | Distress Thermometer 60 Days After Skilled Nursing Facility Discharge | Caregiver distress will be measured using the Distress Thermometer, which includes 1 item on an 11-point scale, measuring negative affect (e.g., sadness and fear) related to caregiving for a severely ill person. Score ranges 0-10, with scores >4 associated with poor coping and depression. | Posted | Mean | Standard Deviation | score on a scale | 60 Days After Patient's SNF Discharge |
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|
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| Secondary | Self-Reported Days of ED or Hospital Use 30 Days After Skilled Nursing Facility Discharge | Patient's days of acute care use will be measured using the self-reported number of combined number of days the patient spends in the Emergency Department (ED) or hospital in 30 days after SNF discharge. | Data are reported only for participants who had acute care use. | Posted | Mean | Standard Deviation | Days | 30 Days After SNF Discharge |
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|
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| Secondary | Self-Reported Days of ED or Hospital Use 60 Days After Skilled Nursing Facility Discharge | Patient's days of acute care use will be measured using the self-reported number of combined number of days the patient spends in the ED or hospital in 60 days after SNF discharge. | Data are reported only for participants who had acute care use. | Posted | Mean | Standard Error | Days | 60 Days After SNF Discharge |
|
|
|
|
| 6 |
| 165 |
| 38 |
| 165 |
| 0 |
| 165 |
| EG001 | Connect-Home Caregivers | Caregivers of Connect-Home study patients. | 0 | 165 | 0 | 165 | 0 | 165 |
| EG002 | Control Patients | Standard discharge planning at the skilled nursing facility only. Participants will have data collected at 7, 30, and 60 days post SNF discharge. | 8 | 162 | 34 | 162 | 0 | 162 |
| EG003 | Control Caregivers | Caregivers of Control study patients. | 0 | 162 | 0 | 162 | 0 | 162 |
| Hospitalization Reason Undisclosed | General disorders | Systematic Assessment |
|
| Hospitalization for Racing Heart Issues | Cardiac disorders | Systematic Assessment |
|
| Hospitalization for Neck Laceration Caused by Fall | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Hospitalization due to Mini Stroke | Nervous system disorders | Systematic Assessment |
|
| Hospitalization due to Urinary Tract Infection | Renal and urinary disorders | Systematic Assessment |
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| Hospitalization due to Kidney Issues | Renal and urinary disorders | Systematic Assessment |
|
| Hospitalization Due to Acute Metabolic Encephalopathy | Nervous system disorders | Systematic Assessment |
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| Hospitalization Due to Shortness of Breath | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Hospitalization Due to Low Blood Pressure | Cardiac disorders | Systematic Assessment |
|
| Hospitalization Due to Fluid Build-Up | Cardiac disorders | Systematic Assessment |
|
| Hospitalization Due to Left Thoracentesis | Cardiac disorders | Systematic Assessment |
|
| Hospitalization Due to Fracture Subsequent to Fall | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Hospitalization Due to Gall Bladder Issues | Hepatobiliary disorders | Systematic Assessment |
|
| Hospitalization Due to Atrial Fibrillation | Cardiac disorders | Systematic Assessment |
|
| Hospitalization Due to Cardiac Stent Placement | Cardiac disorders | Systematic Assessment |
|
| Hospitalization Due to Sepsis | Blood and lymphatic system disorders | Systematic Assessment |
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| Hospitalization Due to Skin Infection | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Hospitalization Due to Vasculitis | Vascular disorders | Systematic Assessment |
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| Hospitalization Due to Congestive Heart Failure | Cardiac disorders | Systematic Assessment |
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| Hospitalization Due to Colon Tear | Gastrointestinal disorders | Systematic Assessment |
|
| Hospitalization Due to Pneumonia | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Hospitalization Due to Abdominal Pain | Gastrointestinal disorders | Systematic Assessment |
|
| Hospitalization Due to Pulmonary Embolism | Cardiac disorders | Systematic Assessment |
|
| Hospitalization Due to Lower Extremity Weakness | Musculoskeletal and connective tissue disorders | Systematic Assessment |
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| Hospitalization Due to Tremors | Nervous system disorders | Systematic Assessment |
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| Hospitalization Due to Toe Amputation | Surgical and medical procedures | Systematic Assessment |
|
| Hospitalization Due to Leg Pain | Musculoskeletal and connective tissue disorders | Systematic Assessment |
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| Hospitalization Due to Chest Pain | Cardiac disorders | Systematic Assessment |
|
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