Study Results
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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COMPLETED
NA
10 participants
INTERVENTIONAL
2019-08-05
2019-12-19
Brief Summary
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Detailed Description
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The investigators propose a home-based PAC model that substitutes for treatment in a traditional SNF PAC facility. We believe that rehabilitation following hospitalization in one's home has several benefits: support tailored to one's actual living circumstances, an environment that encourages earlier mobilization, support of and interaction with family and caregivers, and psychosocial benefits of being at home. To promote aging in place, the investigators plan to deploy an innovative and tailored set of SNF PAC services delivered in a patient's home that would allow for discharge from the hospital directly to home, despite the need for more intensive rehabilitative care not currently found in the home setting. The investigators plan to combine a high-touch and high-tech approach that combines novel uses of personnel practicing at the very top of their license (certified nursing assistants, nurses, home health aides) with novel uses of technology (virtual physical therapy with three-dimensional camera feedback, continuous monitoring, and video visits).
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
OTHER
NONE
Study Groups
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Control
Control subjects will receive care at a skilled nursing facility.
No interventions assigned to this group
Intervention
Intervention subjects will go home from the hospital and receive care from a specialized care team.
Skilled Nursing Facility at Home
We plan to deploy an innovative and tailored set of rehabilitation services delivered in a patient's home that would allow for discharge from the hospital directly to home, despite the need for more intensive rehabilitative care not currently found in the home setting. We plan to combine a high-touch and high-tech approach that combines novel uses of personnel practicing at the very top of their license with novel uses of technology.
Interventions
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Skilled Nursing Facility at Home
We plan to deploy an innovative and tailored set of rehabilitation services delivered in a patient's home that would allow for discharge from the hospital directly to home, despite the need for more intensive rehabilitative care not currently found in the home setting. We plan to combine a high-touch and high-tech approach that combines novel uses of personnel practicing at the very top of their license with novel uses of technology.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Requires skilled nursing facility care following hospitalization, as determined by inpatient team
* Lives within 10 miles of Brigham and Women's Hospital (BWH) or Brigham and Women's Faulkner Hospital (BWFH)
* Has capacity to consent
* Likely to return to community dwelling status
* Patient on medical service
* Pending low volume, we reserve ability to phase in patients on surgical services, including orthopedic trauma
Exclusion Criteria
* Undomiciled
* No working heat (October-April), no working air conditioning if forecast \> 80°F (June-September), or no running water
* In police custody
* Resides in facility that does not allow advanced on-site medical care
* Domestic violence screen positive
* Clinical
* Requires care of new ostomy or teaching ostomy care associated with complication
* Requires frequent suctioning, tracheostomy, and/or ventilator needs
* Requires significant durable medical equipment not already in place at home (e.g., Hoyer lift)
* Home unable to accommodate patient in current state as determined by the SNF-at-Home Checklist for Home
* Acute delirium
* End stage renal disease on hemodialysis
* On methadone requiring daily pickup of medication
* Requires administration of intravenous controlled substances
* Requires administration of specialty medications not already in place at home
* Requires transfusion of blood products
* Requires multiple transfers back and forth to hospital for specialty medical care
* Home SNF census is full
18 Years
ALL
No
Sponsors
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Spire Health, Inc.
UNKNOWN
Reflexion Health, Inc.
INDUSTRY
Brigham and Women's Hospital
OTHER
Responsible Party
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David Levine
Principal Investigator
Principal Investigators
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David Levine, MD, MPH, MA
Role: PRINCIPAL_INVESTIGATOR
Brigham and Women's Hospital
Locations
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Brigham and Women's Hospital
Boston, Massachusetts, United States
Brigham and Women's Faulkner Hospital
Boston, Massachusetts, United States
Countries
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References
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Caplan GA, Coconis J, Board N, Sayers A, Woods J. Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial). Age Ageing. 2006 Jan;35(1):53-60. doi: 10.1093/ageing/afi206. Epub 2005 Oct 20.
David S, Sheikh F, Mahajan D, Greenough W, Bellantoni M. Whom Do We Serve? Describing the Target Population for Post-acute and Long-term Care, Focusing on Nursing Facility Settings, in the Era of Population Health in the United States. J Am Med Dir Assoc. 2016 Jul 1;17(7):574-80. doi: 10.1016/j.jamda.2016.05.004. No abstract available.
Mechanic R. Post-acute care--the next frontier for controlling Medicare spending. N Engl J Med. 2014 Feb 20;370(8):692-4. doi: 10.1056/NEJMp1315607. No abstract available.
Chandra A, Dalton MA, Holmes J. Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings. Health Aff (Millwood). 2013 May;32(5):864-72. doi: 10.1377/hlthaff.2012.1262.
Levine DM, Cueva MA, Shi S, Limaj I, Wambolt B, Grabowski DC, Schnipper JL, Pu CT. Skilled Nursing Facility Care at Home for Adults Discharged From the Hospital: A Pilot Randomized Controlled Trial. J Appl Gerontol. 2022 Jun;41(6):1585-1594. doi: 10.1177/07334648221077092. Epub 2022 Mar 10.
Other Identifiers
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2019P001231
Identifier Type: -
Identifier Source: org_study_id