A Randomised Control Trial of a Transitional Care Model in Singapore General Hospital

NCT ID: NCT02351648

Last Updated: 2015-01-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

840 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-10-31

Study Completion Date

2014-12-31

Brief Summary

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To find out if a transitional care model can reduce the rate of unscheduled readmission to the Department of Internal Medicine (DIM) in SGH

Detailed Description

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Hospital with high readmission rate is view as having lower quality of care High readmission rate is view as wasteful healthcare spending

Primary Aim:

To find out if a transitional care model can reduce the rate of unscheduled readmission to the Department of Internal Medicine (DIM) in SGH A readmission episode is defined as an episode of readmission to any tertiary hospital within 30 days after index discharge from SGH

Secondary Aim:

To find out if a transitional care model can reduce the number of visits to the emergency department in SGH To find out the quality of our transitional care model by using a care transition measure (CTM-15)

Conditions

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Chronic Diseases

Keywords

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readmission care transition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Intervention'

Intervention extend from transfer of care to the study team from the initial admission medical team through 90 days after discharge

Intervention in hospital includes the following. Comprehensive discharge planning based on the 6 principles. Discharge planning initially within 24 hours of recruitment Daily ward review of patients Weekly multi-disciplinary meeting Consolidation of medication and follow-up appointment before discharge Assessment of needs before discharge Comprehensive discharge summary and medication record at discharge

Intervention after discharge:

Work done mainly by integrated care nurse Review of patients within 48 hours after discharge via home visit or phone call Subsequent home visit as needed based on patient's needs At least weekly contact with pt or caregiver via telephone Telephone availability working weekday 8 AM to 5 PM Multi-disciplinary meeting for problematic cases Use chronic disease pathway for suitable patients

Group Type EXPERIMENTAL

a transitional care model

Intervention Type OTHER

Intervention extend from transfer of care to the study team from the initial admission medical team through 90 days after discharge

Intervention in hospital includes the following. Comprehensive discharge planning based on the 6 principles. Discharge planning initially within 24 hours of recruitment Daily ward review of patients Weekly multi-disciplinary meeting Consolidation of medication and follow-up appointment before discharge Assessment of needs before discharge Comprehensive discharge summary and medication record at discharge

Intervention after discharge:

Work done mainly by integrated care nurse Review of patients within 48 hours after discharge via home visit or phone call Subsequent home visit as needed based on patient's needs At least weekly contact with pt or caregiver via telephone Telephone availability working weekday 8 AM to 5 PM Multi-disciplinary meeting for problematic cases Use chronic disease pathway for suitable patients

Control'

Patients receive usual standard of care from the internal medicine team

Group Type ACTIVE_COMPARATOR

Control

Intervention Type OTHER

Patients receive usual standard of care from the internal medicine team

Interventions

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a transitional care model

Intervention extend from transfer of care to the study team from the initial admission medical team through 90 days after discharge

Intervention in hospital includes the following. Comprehensive discharge planning based on the 6 principles. Discharge planning initially within 24 hours of recruitment Daily ward review of patients Weekly multi-disciplinary meeting Consolidation of medication and follow-up appointment before discharge Assessment of needs before discharge Comprehensive discharge summary and medication record at discharge

Intervention after discharge:

Work done mainly by integrated care nurse Review of patients within 48 hours after discharge via home visit or phone call Subsequent home visit as needed based on patient's needs At least weekly contact with pt or caregiver via telephone Telephone availability working weekday 8 AM to 5 PM Multi-disciplinary meeting for problematic cases Use chronic disease pathway for suitable patients

Intervention Type OTHER

Control

Patients receive usual standard of care from the internal medicine team

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

-More than 1 admission in the last 90 days

Exclusion Criteria

* Subject is a non-resident
* Subject has no local home address
* Subject is from a long-term care facility during index admission
* Subject is unable to participate in telephone surveillance
* Subject is discharged before takeover
* Subject has impaired decision making capacity without surrogate decision maker
* Subject is pending or currently in critical care unit
* Subject or caregiver is mentally unstable
* Subject is haemodynamically unstable
* Subject requires acute inpatient respiratory support
* Subject requires acute inpatient dialysis support
* Subject pending surgical intervention
* Subject pending transfer to other specialist discipline
* Primary team consultant declined to participate in this research
Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Agency for Integrated Care, Singapore

OTHER

Sponsor Role collaborator

Duke-NUS Graduate Medical School

OTHER

Sponsor Role collaborator

Singapore General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kheng Hock Lee, MBBS

Role: PRINCIPAL_INVESTIGATOR

Singapore General Hospital

Locations

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Singapore General Hospital

Singapore, Singapore, Singapore

Site Status

Countries

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Singapore

References

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Coleman EA, Smith JD, Frank JC, Eilertsen TB, Thiare JN, Kramer AM. Development and testing of a measure designed to assess the quality of care transitions. Int J Integr Care. 2002;2:e02. doi: 10.5334/ijic.60. Epub 2002 Jun 1.

Reference Type BACKGROUND
PMID: 16896392 (View on PubMed)

Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003 Feb 4;138(3):161-7. doi: 10.7326/0003-4819-138-3-200302040-00007.

Reference Type RESULT
PMID: 12558354 (View on PubMed)

Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database Syst Rev. 2006 Oct 18;2006(4):CD004510. doi: 10.1002/14651858.CD004510.pub3.

Reference Type RESULT
PMID: 17054207 (View on PubMed)

Other Identifiers

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2012/848/E

Identifier Type: -

Identifier Source: org_study_id