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| Name | Class |
|---|---|
| Independence Blue Cross | OTHER |
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The investigators test the PATH program to evaluate whether the program allows patients to spend more days at home in comparison to patients who receive regular care. The program will involve patients from Penn Presbyterian Medical Center with a set of diagnoses and will provide patients with enhanced services upon discharge from the emergency department.
The PATH program seeks to provide patients with enhanced services upon discharge from the emergency department, including visiting home nurses, visiting home physical and occupational therapists, scheduled frequent telephone visits with a medical provider, care coordination to arrange outpatient evaluation and testing, social work services, and other services. The purpose of this study is to evaluate whether the PATH program allows patients to spend more days at home in comparison to patients who receive regular care.
The broad goal of this program is to provide patients with a personalized package of enhanced services following discharge from the emergency department. In some cases, patients enrolled in the PATH program are likely to be discharged home regardless of enrollment, but are deemed potentially high-risk for returning to the hospital due to their illness or other factors. In other cases, enrolled patients might otherwise have been hospitalized but decide with their clinician that recovery at home is possible with the increased supervision and care provided by PATH. For all patients, we seek to determine whether PATH is effective in expediting patient recovery from acute illness and reduce the time spent in hospital or nursing facilities.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PATH Intervention | Experimental | Patients in the treatment arm will receive a personalized plan of care upon discharge from the emergency department. |
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| Routine Care | No Intervention | Patients in the control arm will receive standard-of-care services (the care plan that the emergency physician would normally offer if PATH were not available) without PATH enrollment. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PATH Intervention | Other | Patients will receive an enhanced level of care and service:
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| Measure | Description | Time Frame |
|---|---|---|
| Days at home over 30 days | The number 30 minus the amount of days that patients spend in a hospital, nursing facility, or ED after discharge from the initial ED visit | 30 days |
| Days that patients are expired | The number of days that patients are expired | 30 days |
| Measure | Description | Time Frame |
|---|---|---|
| Impact of PATH on hospital operations - Capture rate | Percentage of eligible patients enrolled into the program (capture rate) | 5 months |
| Quality of life at 30 days | This will be measured using the EQ-5D-5L questionnaire. This questionnaire measures quality of life on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each level is rated on scale that describes the degree of problems in that area. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Austin Kilaru, MD, MSHP | University of Pennsylvania | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Pennsylvania | Philadelphia | Pennsylvania | 19104 | United States |
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| ID | Term |
|---|---|
| D004630 | Emergencies |
| D010342 | Patient Acceptance of Health Care |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D000074822 | Treatment Adherence and Compliance |
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| 5 months |
| Functional status at 30 days | This will be measured using the Lawton and Brody Instrumental Activities of Daily Living (Lawton-Brody IADL) Scale. This instrument assesses independent living skills and functional ability with 8 questions, including behaviors like telephoning, shopping, food preparation, housekeeping, laundering, use of transportation, use of medicine, and financial behavior. The scale is scored dichotomously (0= less able, 1= more able). The higher the score, the greater the person's abilities. Women are scored on all 8 areas of function, but, for men, the areas of food preparation, housekeeping, laundering are excluded. A summary score ranges from 0 (low function, dependent) to 8 (high function, independent) for women, and 0 to 5 for men. | 5 months |
| Estimated cost (allowed charges) based on healthcare utilization | This will be determined by calculating allowed charges for healthcare services delivered to patient over 30-day follow up period. | 5 months |
| Impact of PATH on hospital operations - percentage of hospitalized patients | Measured by potential eligible hospitalizations (patients screened as eligible if more likely to have been hospitalized from the ED); actual avoided hospitalizations (patients more likely to have been hospitalized from the ED who are enrolled in either treatment or control arm); and actual avoided hospitalizations (patients more likely to have been hospitalized from the ED and enrolled in the treatment arm). | 5 months |
| D015438 | Health Behavior |
| D001519 | Behavior |