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CompletedNCT00244491Updated Aug 13, 2015

The Care Transitions Intervention

An interventional study of Care Transitions Intervention in Continuity of Patient Care, sponsored by University of Colorado, Denver. Completed at 1 site in United States. Open to participants aged 65 Years and older. Per ClinicalTrials.gov, last updated 2015-08-13.

Sponsored by University of Colorado, Denver · Not applicable and Interventional

Phase
Not applicable
Study type
Interventional
Enrollment
1,400
Allocation
Randomized
Ages
65 Years and older
Sex
All
01

Study summary

This intervention tests whether encouraging older patients and their caregivers to assert a more active role in their care transitions could improve clinical outcomes. Patients are supported by a nurse transition coach and specific tools, including a Personal Health Record.

Read the detailed description

See above.

02

Conditions studied

  • Continuity of Patient Care

Keywords

  • care transitions
  • geriatric
  • care coordination
  • self-management
  • chronic illness
  • patient-centered care
03

In context

Lead sponsor

University of Colorado, Denver is the lead sponsor of 1,499 studies on the registry; 315 are open to participants now.

Of its 139 completed or terminated interventional studies of FDA-regulated products, 89 (64%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
65 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • To be eligible for this study, patients from the participating delivery system had to: 1) be age 65 years or older, 2) be admitted to one of the participating delivery system's contract hospitals during the study period for a non-psychiatrically-related condition, 3) be community-dwelling (i.e., not from a long-term care facility), 4) reside within a predefined geographic radius of the hospital (thereby making a home visit feasible), 5) have a working telephone, 6) be English-speaking, 7) show no documentation of dementia in the medical record, 8) have no plans to enter hospice, 9) not be participating in another research protocol, and 10) have documented in their medical record at least one of 11 diagnoses, including stroke, congestive heart failure, coronary artery disease, cardiac arrhythmias, chronic obstructive pulmonary disease, diabetes, spinal stenosis, hip fracture, peripheral vascular disease, deep venous thrombosis, or pulmonary embolism.

Exclusion criteria

Exclusion Criteria:

  • Those who did not meet the inclusion criteria.
05

Study design

Phase
Not applicable
Allocation
Randomized
Intervention model
Single group
Masking
None (open label)
Enrollment
1,400 participants

Interventions

  • BehavioralCare Transitions Intervention
06

What researchers measure

Primary outcomes

  1. Rehospitalization rate at 30, 90 and 180 days after index hospitalization.

Secondary outcomes

  1. Rehospitalization rate at 30, 90 and 180 days after index hospitalization. Rehospitalization for the same condition as the index hospital stay, at 30, 90 and 180 days.

07

Study locations

1 site
  • University of Colorado Health Sciences Center
    Denver, Colorado 80262, United States
08

References and documents

Publications

  • Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006 Sep 25;166(17):1822-8. doi: 10.1001/archinte.166.17.1822. PubMed 17000937 ↗
09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Aug 13, 2015, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT00244491
Lead sponsor
University of Colorado, Denver
Collaborators
The John A. Hartford Foundation
Responsible party
Sponsor
First posted
Oct 26, 2005
Start date
Sep 2002
Completion
Aug 2003
Last update
Aug 13, 2015

Study contacts

Eric A. Coleman, MD, MPH
principal investigator · University of Colorado, Denver
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Aug 2015. You cannot join it, but the record below documents what was studied.

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