Trial Outcomes & Findings for Rural Options At Discharge Model of Active Planning (NCT NCT02684188)
NCT ID: NCT02684188
Last Updated: 2017-11-20
Results Overview
Number of admissions to any hospital reported by the patients after discharge from a regional hospital to one of four rural counties.
Recruitment status
COMPLETED
Study phase
NA
Target enrollment
127 participants
Primary outcome timeframe
3, 7 ,14, 21, 30, 60, and 90 days after discharge
Results posted on
2017-11-20
Participant Flow
We recruited participants from among patients admitted to Saint Patrick Hospital, a regional referral hospital, from one of four counties. All four were non-metropolitan counties and three of the counties met the criteria of being a frontier county (population of less than 6 people per square mile).
Participant milestones
| Measure |
Standard Hospital Discharge Planning Services
Patients receive standard discharge planning services.
|
Enhanced Discharge Planning and Rural Transition Supports
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transition needs and the provision of recovery supports to the patient.
Enhanced Transitions Planning: While in the treating hospital, patients from small towns and rural communities are engaged in a process designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs. Once home, a Local Community Transition Coordinator provides support to address needs.
|
|---|---|---|
|
Overall Study
STARTED
|
77
|
50
|
|
Overall Study
COMPLETED
|
75
|
47
|
|
Overall Study
NOT COMPLETED
|
2
|
3
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
We analyzed LACE+ data for 112 patients as the electronic medical record did not establish this measure until after the study started.
Baseline characteristics by cohort
| Measure |
Current Treatment
n=77 Participants
Patients receive that current discharge planning services and supports.
|
Enhanced Transitions Planning
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Transitions Planning: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
Total
n=127 Participants
Total of all reporting groups
|
|---|---|---|---|
|
Age, Continuous
|
59.9 years
n=77 Participants
|
63.2 years
n=50 Participants
|
61.2 years
n=127 Participants
|
|
Sex: Female, Male
Female
|
34 Participants
n=77 Participants
|
21 Participants
n=50 Participants
|
55 Participants
n=127 Participants
|
|
Sex: Female, Male
Male
|
43 Participants
n=77 Participants
|
29 Participants
n=50 Participants
|
72 Participants
n=127 Participants
|
|
Ethnicity (NIH/OMB)
Hispanic or Latino
|
0 Participants
n=77 Participants
|
0 Participants
n=50 Participants
|
0 Participants
n=127 Participants
|
|
Ethnicity (NIH/OMB)
Not Hispanic or Latino
|
72 Participants
n=77 Participants
|
47 Participants
n=50 Participants
|
119 Participants
n=127 Participants
|
|
Ethnicity (NIH/OMB)
Unknown or Not Reported
|
5 Participants
n=77 Participants
|
3 Participants
n=50 Participants
|
8 Participants
n=127 Participants
|
|
Race (NIH/OMB)
American Indian or Alaska Native
|
7 Participants
n=77 Participants
|
6 Participants
n=50 Participants
|
13 Participants
n=127 Participants
|
|
Race (NIH/OMB)
Asian
|
0 Participants
n=77 Participants
|
0 Participants
n=50 Participants
|
0 Participants
n=127 Participants
|
|
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
|
1 Participants
n=77 Participants
|
0 Participants
n=50 Participants
|
1 Participants
n=127 Participants
|
|
Race (NIH/OMB)
Black or African American
|
0 Participants
n=77 Participants
|
0 Participants
n=50 Participants
|
0 Participants
n=127 Participants
|
|
Race (NIH/OMB)
White
|
67 Participants
n=77 Participants
|
43 Participants
n=50 Participants
|
110 Participants
n=127 Participants
|
|
Race (NIH/OMB)
More than one race
|
0 Participants
n=77 Participants
|
0 Participants
n=50 Participants
|
0 Participants
n=127 Participants
|
|
Race (NIH/OMB)
Unknown or Not Reported
|
2 Participants
n=77 Participants
|
1 Participants
n=50 Participants
|
3 Participants
n=127 Participants
|
|
Region of Enrollment
United States
|
77 participants
n=77 Participants
|
50 participants
n=50 Participants
|
127 participants
n=127 Participants
|
|
Patient Activation Measure (PAM10)
|
65.1 units on a scale
n=77 Participants
|
73.8 units on a scale
n=50 Participants
|
69.9 units on a scale
n=127 Participants
|
|
Length of Stay, Acuity, Co-morbidity, and Emergency Department Visits (LACE+)
|
42.2 units on a scale
n=62 Participants • We analyzed LACE+ data for 112 patients as the electronic medical record did not establish this measure until after the study started.
|
49.7 units on a scale
n=50 Participants • We analyzed LACE+ data for 112 patients as the electronic medical record did not establish this measure until after the study started.
|
46.3 units on a scale
n=112 Participants • We analyzed LACE+ data for 112 patients as the electronic medical record did not establish this measure until after the study started.
|
PRIMARY outcome
Timeframe: 3, 7 ,14, 21, 30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
Number of admissions to any hospital reported by the patients after discharge from a regional hospital to one of four rural counties.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Hospital Re-admissions Analyzed by Poisson Regression
3 days after discharge
|
17 Hospital Readmission
|
4 Hospital Readmission
|
|
Hospital Re-admissions Analyzed by Poisson Regression
7 days after discharge
|
21 Hospital Readmission
|
5 Hospital Readmission
|
|
Hospital Re-admissions Analyzed by Poisson Regression
14 days after discharge
|
23 Hospital Readmission
|
7 Hospital Readmission
|
|
Hospital Re-admissions Analyzed by Poisson Regression
21 days after discharge
|
25 Hospital Readmission
|
7 Hospital Readmission
|
|
Hospital Re-admissions Analyzed by Poisson Regression
30 days after discharge
|
25 Hospital Readmission
|
9 Hospital Readmission
|
|
Hospital Re-admissions Analyzed by Poisson Regression
60 days after discharge
|
28 Hospital Readmission
|
10 Hospital Readmission
|
|
Hospital Re-admissions Analyzed by Poisson Regression
90 days after discharge
|
26 Hospital Readmission
|
12 Hospital Readmission
|
PRIMARY outcome
Timeframe: 3, 7 ,14, 21, 30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
Proportion of patients who self-report at least one hospital readmission to any hospital after discharge from a regional hospital to one of four rural counties.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Hospital Re-admissions Analyzed by Logistic Regression
3 days after discharge
|
0.10 proportion of patients rehospitalized
|
0.07 proportion of patients rehospitalized
|
|
Hospital Re-admissions Analyzed by Logistic Regression
7 days after discharge
|
0.12 proportion of patients rehospitalized
|
0.07 proportion of patients rehospitalized
|
|
Hospital Re-admissions Analyzed by Logistic Regression
14 days after discharge
|
0.11 proportion of patients rehospitalized
|
0.09 proportion of patients rehospitalized
|
|
Hospital Re-admissions Analyzed by Logistic Regression
21 days after discharge
|
0.16 proportion of patients rehospitalized
|
0.10 proportion of patients rehospitalized
|
|
Hospital Re-admissions Analyzed by Logistic Regression
30 days after discharge
|
0.16 proportion of patients rehospitalized
|
0.18 proportion of patients rehospitalized
|
|
Hospital Re-admissions Analyzed by Logistic Regression
60 days after discharge
|
0.19 proportion of patients rehospitalized
|
0.18 proportion of patients rehospitalized
|
|
Hospital Re-admissions Analyzed by Logistic Regression
90 days after discharge
|
0.18 proportion of patients rehospitalized
|
0.21 proportion of patients rehospitalized
|
PRIMARY outcome
Timeframe: 3, 7, 14, 21,30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
Number of self-reported visits to the emergency department of any hospital reported by patients after discharge from a regional hospital to one of four rural counties.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Emergency Department (ED) Visits Analyzed by Poisson Regression
3 days after discharge
|
9 Emergency Department Visits
|
6 Emergency Department Visits
|
|
Emergency Department (ED) Visits Analyzed by Poisson Regression
7 days after discharge
|
18 Emergency Department Visits
|
11 Emergency Department Visits
|
|
Emergency Department (ED) Visits Analyzed by Poisson Regression
14 days after discharge
|
27 Emergency Department Visits
|
17 Emergency Department Visits
|
|
Emergency Department (ED) Visits Analyzed by Poisson Regression
21 days after discharge
|
38 Emergency Department Visits
|
19 Emergency Department Visits
|
|
Emergency Department (ED) Visits Analyzed by Poisson Regression
30 days after discharge
|
43 Emergency Department Visits
|
19 Emergency Department Visits
|
|
Emergency Department (ED) Visits Analyzed by Poisson Regression
60 days after discharge
|
47 Emergency Department Visits
|
19 Emergency Department Visits
|
|
Emergency Department (ED) Visits Analyzed by Poisson Regression
90 days after discharge
|
48 Emergency Department Visits
|
21 Emergency Department Visits
|
PRIMARY outcome
Timeframe: 3, 7, 14, 21,30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
Proportion of patients who report at least one emergency department visit after discharge from a regional hospital to one of four rural counties.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Emergency Department (D) Visits Analyzed by Logistic Regression
3 days after discharge
|
0.10 participants with at least one ED visit
|
0.09 participants with at least one ED visit
|
|
Emergency Department (D) Visits Analyzed by Logistic Regression
7 days after discharge
|
0.15 participants with at least one ED visit
|
0.11 participants with at least one ED visit
|
|
Emergency Department (D) Visits Analyzed by Logistic Regression
14 days after discharge
|
0.16 participants with at least one ED visit
|
0.14 participants with at least one ED visit
|
|
Emergency Department (D) Visits Analyzed by Logistic Regression
21 days after discharge
|
0.22 participants with at least one ED visit
|
0.19 participants with at least one ED visit
|
|
Emergency Department (D) Visits Analyzed by Logistic Regression
30 days after discharge
|
0.24 participants with at least one ED visit
|
0.20 participants with at least one ED visit
|
|
Emergency Department (D) Visits Analyzed by Logistic Regression
60 days after discharge
|
0.29 participants with at least one ED visit
|
0.23 participants with at least one ED visit
|
|
Emergency Department (D) Visits Analyzed by Logistic Regression
90 days after discharge
|
.29 participants with at least one ED visit
|
0.23 participants with at least one ED visit
|
PRIMARY outcome
Timeframe: 3, 7, 14, 21, 30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to a regional referral hospital for treatment, who enrolled in the study and were discharged to one of four rural counties.
This reflects the number of visits to a patient's local primary care provider at 3, 7, 14, 21,30, 60, and 90 days after discharge.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Primary Care Provider (PCP) Visits Analyzed by Poisson Regression
3 days after discharge
|
7 Primary Care Provider Visits
|
2 Primary Care Provider Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Poisson Regression
7 days after discharge
|
27 Primary Care Provider Visits
|
19 Primary Care Provider Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Poisson Regression
14 days after discharge
|
54 Primary Care Provider Visits
|
45 Primary Care Provider Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Poisson Regression
21 days after discharge
|
71 Primary Care Provider Visits
|
50 Primary Care Provider Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Poisson Regression
30 days after discharge
|
91 Primary Care Provider Visits
|
49 Primary Care Provider Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Poisson Regression
60 days after discharge
|
135 Primary Care Provider Visits
|
59 Primary Care Provider Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Poisson Regression
90 days after discharge
|
148 Primary Care Provider Visits
|
83 Primary Care Provider Visits
|
PRIMARY outcome
Timeframe: 3, 7, 14, 21, 30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to a regional referral hospital for treatment, who enrolled in the study and were discharged to one of four rural counties.
This reflects the proportion of patients who reported at least one visit to a their local primary care provider at 3, 7, 14, 21,30, 60, and 90 days after discharge.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Primary Care Provider (PCP) Visits Analyzed by Logistic Regression
3 days after discharge
|
0.07 Proportion with Primary Care Visits
|
0.05 Proportion with Primary Care Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Logistic Regression
7 days after discharge
|
0.31 Proportion with Primary Care Visits
|
0.32 Proportion with Primary Care Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Logistic Regression
14 days after discharge
|
0.47 Proportion with Primary Care Visits
|
0.51 Proportion with Primary Care Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Logistic Regression
21 days after discharge
|
0.60 Proportion with Primary Care Visits
|
0.53 Proportion with Primary Care Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Logistic Regression
30 days after discharge
|
0.63 Proportion with Primary Care Visits
|
0.55 Proportion with Primary Care Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Logistic Regression
60 days after discharge
|
0.74 Proportion with Primary Care Visits
|
0.64 Proportion with Primary Care Visits
|
|
Primary Care Provider (PCP) Visits Analyzed by Logistic Regression
90 days after discharge
|
0.80 Proportion with Primary Care Visits
|
0.70 Proportion with Primary Care Visits
|
SECONDARY outcome
Timeframe: 3, 7, 14, 21, 30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
The SF12 is a twelve-item standardized questionnaire that measures overall, physical health, and mental health. Patients rate each item on an ordinal scale. Data are analyzed using a proprietary algorithm. Scores range from 0 to 100. Higher scores reflect a better health status. The analysis creates an overall health score and sub scores that reflect physical health and mental health. Both Physical and Mental Health Composite Scales combine the 12 items in such a way that they compare to a national norm of a mean score of 50.0 and a standard deviation of 10.0.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Short Form (SF12) Physical Health Score
3 days after discharge
|
35.1 units on a scale
Standard Deviation 7.8
|
36.3 units on a scale
Standard Deviation 7.9
|
|
Short Form (SF12) Physical Health Score
7 days after discharge
|
34.7 units on a scale
Standard Deviation 6.6
|
35.1 units on a scale
Standard Deviation 7.5
|
|
Short Form (SF12) Physical Health Score
14 days after discharge
|
35.7 units on a scale
Standard Deviation 6.4
|
36.0 units on a scale
Standard Deviation 6.7
|
|
Short Form (SF12) Physical Health Score
21 days after discharge
|
36.3 units on a scale
Standard Deviation 6.1
|
36.4 units on a scale
Standard Deviation 5.9
|
|
Short Form (SF12) Physical Health Score
30 days after discharge
|
37.3 units on a scale
Standard Deviation 6.0
|
37.2 units on a scale
Standard Deviation 7.1
|
|
Short Form (SF12) Physical Health Score
60 days after discharge
|
39.2 units on a scale
Standard Deviation 5.8
|
39.0 units on a scale
Standard Deviation 6.5
|
|
Short Form (SF12) Physical Health Score
90 days after discharge
|
40.3 units on a scale
Standard Deviation 6.0
|
39.9 units on a scale
Standard Deviation 6.1
|
SECONDARY outcome
Timeframe: 3, 7, 14, 21, 30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
The SF12 is a twelve-item standardized questionnaire that measures overall, physical health, and mental health. Patients rate each item on an ordinal scale. Data are analyzed using a proprietary algorithm. Scores range from 0 to 100. Higher scores reflect a better health status. The analysis creates an overall health score and sub scores that reflect physical health and mental health. Both Physical and Mental Health Composite Scales combine the 12 items in such a way that they compare to a national norm of a mean score of 50.0 and a standard deviation of 10.0.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Short Form (SF12) Mental Health Score
3 days after discharge
|
47.8 units on a scale
Standard Deviation 12.1
|
47.2 units on a scale
Standard Deviation 11.2
|
|
Short Form (SF12) Mental Health Score
7 days after discharge
|
50.0 units on a scale
Standard Deviation 12.5
|
49.3 units on a scale
Standard Deviation 13.0
|
|
Short Form (SF12) Mental Health Score
14 days after discharge
|
51.8 units on a scale
Standard Deviation 10.9
|
50.9 units on a scale
Standard Deviation 10.5
|
|
Short Form (SF12) Mental Health Score
21 days after discharge
|
53.9 units on a scale
Standard Deviation 10.6
|
54.5 units on a scale
Standard Deviation 10.5
|
|
Short Form (SF12) Mental Health Score
30 days after discharge
|
53.8 units on a scale
Standard Deviation 10.0
|
53.4 units on a scale
Standard Deviation 11.0
|
|
Short Form (SF12) Mental Health Score
60 days after discharge
|
54.4 units on a scale
Standard Deviation 8.7
|
53.6 units on a scale
Standard Deviation 8.9
|
|
Short Form (SF12) Mental Health Score
90 days after discharge
|
54.8 units on a scale
Standard Deviation 10.2
|
54.4 units on a scale
Standard Deviation 9.2
|
SECONDARY outcome
Timeframe: 3 days after dischargePopulation: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
The CTM3 is a three-item standardized questionnaire to measures patients' perspectives on coordination of hospital discharge care. Patients rate whether they strongly agree, agree, disagree, or strongly disagree with three items (hospital staff too my preferences into account, I had a good idea what I was responsible for once I left the hospital, and I clearly understood the purpose for taking each of my medications). They may also rate an items as not applicable to their situation. Ratings are converted to a scale that ranges from 0 to 100. Higher scores reflect better discharge care.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=68 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=44 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
|
|---|---|---|
|
Care Transition Measure (CTM3)
|
0.86 Survey Response Scores
Standard Deviation 0.18
|
0.80 Survey Response Scores
Standard Deviation 0.26
|
SECONDARY outcome
Timeframe: 7, 14, 21, 30, 60, and 90 days after dischargePopulation: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
The RTM14 is a fourteen-item questionnaire to measures patients' perspectives on the delivery of transition services and supports after discharge from a regional hospital to a small town or rural community. Patients respond by indicating whether they strongly disagree, disagree, agree, or strongly agree with each of the 14 items. Patients may also indicate whether an item is not applicable to their situation. Ratings are converted to a scale that ranges from 0 to 100. Higher scores reflect better transition service performance.
Outcome measures
| Measure |
Standard Hospital Discharge Services
n=77 Participants
Patients received standard discharge planning; the baseline and return to baseline groups were combined to form a single standard discharge group
|
Enhanced Discharge & Rural Transition Support
n=50 Participants
The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Discharge Planning \& Rural Transition Support: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
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Rural Transition Measure (RTM14)
7 days after discharge
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0.854 Survey Response Scores
Standard Deviation 0.173
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0.884 Survey Response Scores
Standard Deviation 0.149
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Rural Transition Measure (RTM14)
14 days after discharge
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0.897 Survey Response Scores
Standard Deviation 0.131
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0.873 Survey Response Scores
Standard Deviation 0.161
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Rural Transition Measure (RTM14)
21 days after discharge
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0.922 Survey Response Scores
Standard Deviation 0.118
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0.876 Survey Response Scores
Standard Deviation 0.158
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Rural Transition Measure (RTM14)
30 days after discharge
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0.902 Survey Response Scores
Standard Deviation 0.133
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0.895 Survey Response Scores
Standard Deviation 0.147
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Rural Transition Measure (RTM14)
60 days after discharge
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0.901 Survey Response Scores
Standard Deviation 0.120
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0.924 Survey Response Scores
Standard Deviation 0.092
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Rural Transition Measure (RTM14)
90 days after discharge
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0.901 Survey Response Scores
Standard Deviation 0.163
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0.911 Survey Response Scores
Standard Deviation 0.107
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Adverse Events
Standard Hospital Discharge Planning Services
Serious events: 0 serious events
Other events: 0 other events
Deaths: 2 deaths
Enhanced Discharge Planning and Rural Transition Supports
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
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place