Paramedic Coached ED Care Transitions to Help Older Adults Maintain Their Health

Browse trials for

• Emergencies 1,692

Emergencies

1,692 studies on the registry are indexed under Emergencies; 333 are open to participants now.

This study's enrollment of 1,979 is above the median of 145 across 931 interventional studies indexed under Emergencies.

Lead sponsor

University of Wisconsin, Madison is the lead sponsor of 1,161 studies on the registry; 182 are open to participants now.

Of its 151 completed or terminated interventional studies of FDA-regulated products, 114 (75%) have results posted.

Study arms

• No intervention
  Usual Care

  Older adults discharged from an ED to home who receive the usual processes and services.

• Active comparator
  Care Transitions Intervention

  Older adults discharged from an ED to home who receive the Care Transitions Intervention.

  Behavioral: Care Transitions Intervention

Interventions

• BehavioralCare Transitions Intervention

  The Care Transitions Intervention uses coaches, in this case paramedics, to support patients being discharged home by transferring skills to activate patients.

Primary outcomes

1. Number of Participants Returning to the ED Within 30 Days of the Original ED Visit

   The investigators included all unplanned ED use, regardless of reason, during the 30 days after discharge as abstracted from electronic medical records (with out-of-system ED use identified during participant phone surveys). The investigators constructed dichotomous variables measuring whether or not any ED visits occurred within 14 and 30 days after discharge, with the 30-day interval being the primary prespecified outcome. Control vs Intent-to-Treat vs Per Protocol population reported.

   Time frame: 30 days after emergency department discharge

2. Time to Any Follow up (in Person or Phone) With PCP, Specialists, or Urgent Care

   Follow-up visits, abstracted from participant medical records, included office visits with primary or specialty providers, telephone calls, and online patient portal messaging (excluding automated reminder messages, electronic messages that did not receive a patient response, laboratory testing, and previously scheduled outpatient procedures). Outpatient follow-up was dichotomized by whether or not any contact with outpatient providers occurred within either 7 or 30 days of discharge. This approach allowed us to differentiate follow-up occurring soon after discharge (consistent with most ED discharge instructions) from less-timely contact with outpatient clinics. To conduct a preplanned subanalysis, we also categorized all follow-up as either "in-person" or "electronic." Dichotomous variables were created for each modality at each time point as well as a combined variable representing all forms of contact. Control vs Intent-To-Treat vs Per Protocol population reported.

   Time frame: Medical records reviewed for number of participants who followed up within 7 and 30 days, augmented by participant surveys at day 4 and 30 to learn about non-University of Wisconsin hospital visits

3. Number of Participants With Urgent Care or Unplanned Hospitalizations Within 30 Days of ED Discharge

   Control vs Intent-to-Treat vs Per Protocol Population reported

   Time frame: up to 30 days

Secondary outcomes

1. Number of Participants With Medication Changes Implemented

   The investigators asked participants to self-report any medication changes (starts, stops, or modifications) they had made since discharge during the 4-day survey. They had to provide the name, classification, or purpose of each medication. Medically trained researchers compared self-reported medication changes to those listed on participants' AVS discharge instructions, excluding those with "as needed" instructions. The dichotomized variable indicates whether or not the participant reported making all recommended medication changes.

   Time frame: day 4

2. Number of Participants Who Could Recall Any Specific Red Flag

   The discharge instructions from the ED will be abstracted for key red flags. Participants will be asked to list the red flags for which they are monitoring their condition.

   Time frame: day 4

3. Level of Participant Activation as Measured by the Perceived Health Competence Survey

   Perceived Health Competence Score (PHCS) has a total possible range of scores from 8-40 where higher scores indicate a stronger perception of health competency. This is also known as the Wallston score.

   Time frame: 30 days after emergency department discharge

4. Median Cost of Healthcare Services Within 30 Days of the Original ED Visit

   Time frame: 30 days after emergency department discharge

Other outcomes

1. Program Satisfaction Survey Score

   Participants and Caregivers were surveyed for their satisfaction with the intervention, on a scale of 0-10 where 0 is the worst experience and 10 is the best experience.

   Time frame: day 1, day 30

2. Family Caregiver Activation in Transitions (FCAT)

   The Family Caregiver Activation in Transitions survey is a series of statements about challenges commonly faced by those caring for a loved one. It is scored on a 6 point likert scale for a total possible range between 10-60, where higher scores indicate fewer challenges to care.

   Time frame: day 1, day 30

3. Number of Participants Who Died Within 30 Days of Discharge

   Time frame: up to 30 days

Baseline characteristics

9 further baseline measures are reported on the registry.

Publications

• Mi R, Hollander MM, Jones CMC, DuGoff EH, Caprio TV, Cushman JT, Kind AJH, Lohmeier M, Shah MN. A randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisits. BMC Geriatr. 2018 May 3;18(1):104. doi: 10.1186/s12877-018-0792-5. PubMed 29724172 ↗

Study documents

• Protocol and statistical analysis plan · Oct 10, 2016

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No