Trial Outcomes & Findings for Transition From Hospital to Home Post Cardiac Condition (NCT NCT01431846)

Results Overview

Follow up appointment within 2 weeks of discharge back to their primary care providers at a primary care facility from a tertiary referral center.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

19 participants

Primary outcome timeframe

Within 2 weeks of discharge

Results posted on

2015-04-28

Participant Flow

Participant milestones

Participant milestones
Measure	Arm 1 Eight patients who were being discharged from Denver VA Medical Center for cardiac care to their primary care providers were recruited at the time of discharge and completed an interview two weeks following their discharge. Patients were asked to describe their transition to home and identify barriers and facilitators of this process, their understanding of their medical condition, new medications prescribed, timeliness of follow-up visit with their PCP and knowledge of signs/symptoms in which they should seek medical attention.	Arm 2 Three providers who refer patients to the Denver VA Medical Center for cardiac care were interviewed to identify barriers and facilitators from their perspective of following-up with patients after their hospitalization at Denver VAMC. Additionally, the same information was asked of providers who participated in two focus groups in the Grand Junction VA.	Arm 3 Informed by interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1)PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical attention Intervention: Informed by the interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1) PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical attention
Overall Study STARTED	8	3	8
Overall Study COMPLETED	8	3	8
Overall Study NOT COMPLETED	0	0	0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Transition From Hospital to Home Post Cardiac Condition

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Arm 1 n=8 Participants Eight patients who were being discharged from Denver VA Medical Center for cardiac care to their primary care providers were recruited at the time of discharge and completed an interview two weeks following their discharge. Patients were asked to describe their transition to home and identify barriers and facilitators of this process, their understanding of their medical condition, new medications prescribed, timeliness of follow-up visit with their PCP and knowledge of signs/symptoms in which they should seek medical attention.	Arm 2 n=3 Participants Three providers who refer patients to the Denver VA Medical Center for cardiac care were interviewed to identify barriers and facilitators from their perspective of following-up with patients after their hospitalization at Denver VAMC. Additionally, the same information was asked of providers who participated in two focus groups in the Grand Junction VA.	Arm 3 n=8 Participants Informed by the interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1)PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical attention Intervention: Informed by the interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1) PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical att	Total n=19 Participants Total of all reporting groups
Age, Categorical <=18 years	0 participants n=5 Participants	0 participants n=7 Participants	0 participants n=5 Participants	0 participants n=4 Participants
Age, Categorical Between 18 and 65 years	0 participants n=5 Participants	NA participants n=7 Participants	0 participants n=5 Participants	NA participants n=4 Participants
Age, Categorical >=65 years	8 participants n=5 Participants	NA participants n=7 Participants	8 participants n=5 Participants	NA participants n=4 Participants
Sex: Female, Male Female	4 Participants n=5 Participants	NA Participants n=7 Participants	4 Participants n=5 Participants	NA Participants n=4 Participants
Sex: Female, Male Male	4 Participants n=5 Participants	NA Participants n=7 Participants	4 Participants n=5 Participants	NA Participants n=4 Participants
Region of Enrollment United States	8 participants n=5 Participants	3 participants n=7 Participants	8 participants n=5 Participants	19 participants n=4 Participants

PRIMARY outcome

Timeframe: Within 2 weeks of discharge

Follow up appointment within 2 weeks of discharge back to their primary care providers at a primary care facility from a tertiary referral center.

Outcome measures

Outcome measures
Measure	Arm 1 n=8 Participants Eight patients who were being discharged from Denver VA Medical Center for cardiac care to their primary care providers were recruited at the time of discharge and completed an interview two weeks following their discharge. Patients were asked to describe their transition to home and identify barriers and facilitators of this process, their understanding of their medical condition, new medications prescribed, timeliness of follow-up visit with their PCP and knowledge of signs/symptoms in which they should seek medical attention.	Arm 2 n=3 Participants Three providers who refer patients to the Denver VA Medical Center for cardiac care were interviewed to identify barriers and facilitators from their perspective of following-up with patients after their hospitalization at Denver VAMC. Additionally, the same information was asked of providers who participated in two focus groups in the Grand Junction VA.	Arm 3 n=8 Participants Informed by interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1)PCP follow-up within 2-4 weeks of hospital discharge; 2)medications reconciled between pre and post-hospital discharge; 3)discharge summary available to PCP at time of visit; and 4)patient awareness of symptoms that require medical attention Intervention: Informed by the interviews and best practices from the literature, pilot test the transitions of care intervention that targets patients and providers to evaluate the feasibility of the intervention to improve process of care measures, including: 1) PCP follow-up within 2-4 weeks of hospital discharge; 2) medications reconciled between pre and post-hospital discharge; 3) discharge summary available to PCP at time of visit; and 4) patient awareness of symptoms that require medical attention
See Primary Outcome Description Below Medication reconciliation	4 participants	NA participants All providers interviewed to understand facilitators and barriers. This outcome does not pertain to providers.	8 participants
See Primary Outcome Description Below Subjects Interviewed	8 participants	3 participants	8 participants
See Primary Outcome Description Below Follow-up within 2 weeks of discharge	3 participants	NA participants All providers interviewed to understand facilitators and barriers. This outcome does not pertain to providers.	6 participants
See Primary Outcome Description Below Discharge Instructions	8 participants	NA participants All providers interviewed to understand facilitators and barriers. This outcome does not pertain to providers.	8 participants

Adverse Events

Discharged Patients

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Providers

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Intervention

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Michael Ho

Eastern Colorado Health Care System

Phone: 720-857-5115

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place