Trial Outcomes & Findings for Living With Multimorbidity: CO-ORDINATE Program (NCT NCT05985044)

NCT ID: NCT05985044

Last Updated: 2025-01-28

Results Overview

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

27 participants

Primary outcome timeframe

Baseline, 6-weeks post intervention, 3 months post intervention

Results posted on

2025-01-28

Participant Flow

The participant was approached and recruited in the Intermediate Care Unit (IMCU) of an academic teaching hospital while the participants are in-patient before discharge. The recruitment of eligible participant took approximately 9 months from November 16, 2022 to August 2, 2023.

Out of the 27 participants who signed the informed consent, 25 completed the baseline survey and received the intervention. Two participants did not complete the baseline data collection and could not be reached after signing the consent form.

Participant milestones

Participant milestones
Measure
Intervention
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Overall Study
STARTED
25
Overall Study
COMPLETED
10
Overall Study
NOT COMPLETED
15

Reasons for withdrawal

Reasons for withdrawal
Measure
Intervention
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Overall Study
Death
6
Overall Study
Lost to Follow-up
4
Overall Study
Incapacitation
3
Overall Study
Withdrawal by Subject
2

Baseline Characteristics

Living With Multimorbidity: CO-ORDINATE Program

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Age, Continuous
67 years
STANDARD_DEVIATION 7 • n=5 Participants
Sex: Female, Male
Female
12 Participants
n=5 Participants
Sex: Female, Male
Male
13 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
5 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
19 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants
n=5 Participants
Race (NIH/OMB)
Asian
0 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
18 Participants
n=5 Participants
Race (NIH/OMB)
White
6 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
Region of Enrollment
United States
25 Participants
n=5 Participants
Symptom burden - Pain
4.34 units on a scale
STANDARD_DEVIATION 3.63 • n=5 Participants
Symptom burden - Tiredness
3.64 units on a scale
STANDARD_DEVIATION 2.89 • n=5 Participants
Symptom burden - Drowsiness
2.48 units on a scale
STANDARD_DEVIATION 2.76 • n=5 Participants
Symptom burden - Nausea
1.52 units on a scale
STANDARD_DEVIATION 2.87 • n=5 Participants
Symptom burden - Lack of appetite
1.02 units on a scale
STANDARD_DEVIATION 2.19 • n=5 Participants
Symptom burden - Shortness of breath
2.16 units on a scale
STANDARD_DEVIATION 2.76 • n=5 Participants
Symptom burden - Depression
1.78 units on a scale
STANDARD_DEVIATION 3.19 • n=5 Participants
Symptom burden - Anxiety
2.3 units on a scale
STANDARD_DEVIATION 2.97 • n=5 Participants
Symptom burden - Well-being
4.48 units on a scale
STANDARD_DEVIATION 3.27 • n=5 Participants
Quality of Life - Physical functioning
43.33 units on a scale
STANDARD_DEVIATION 30.31 • n=5 Participants
Quality of Life - Role Physical
27.08 units on a scale
STANDARD_DEVIATION 36.05 • n=5 Participants
Quality of Life -Role Emotional
48.61 units on a scale
STANDARD_DEVIATION 46.08 • n=5 Participants
Quality of Life - Vitality
42.08 units on a scale
STANDARD_DEVIATION 22.89 • n=5 Participants
Quality of Life - Mental Health
65 units on a scale
STANDARD_DEVIATION 26.49 • n=5 Participants
Quality of Life - Social Functioning
51.04 units on a scale
STANDARD_DEVIATION 35.72 • n=5 Participants
Quality of Life - General health
49.58 units on a scale
STANDARD_DEVIATION 22.07 • n=5 Participants

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Pain
Baseline
5 score on a scale
Interval 0.0 to 8.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Pain
6-week
4 score on a scale
Interval 1.0 to 6.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Pain
3-month
5 score on a scale
Interval 2.0 to 7.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Tiredness
Baseline
3 score on a scale
Interval 2.0 to 5.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Tiredness
6-week
3 score on a scale
Interval 3.0 to 4.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Tiredness
3-month
6 score on a scale
Interval 3.0 to 7.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Drowsiness
Baseline
2 score on a scale
Interval 0.0 to 5.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Drowsiness
6-week
3 score on a scale
Interval 0.0 to 4.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Drowsiness
3-month
5 score on a scale
Interval 2.0 to 6.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Nausea
Baseline
0 score on a scale
Interval 0.0 to 0.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Nausea
6-week
0 score on a scale
Interval 0.0 to 0.3
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Nausea
3-month
1 score on a scale
Interval 0.0 to 2.5

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Lack of Appetite
Baseline
0 score on a scale
Interval 0.0 to 0.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Lack of Appetite
6-week
1 score on a scale
Interval 0.0 to 6.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Lack of Appetite
3-month
3.3 score on a scale
Interval 1.0 to 4.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Shortness of Breath
Baseline
0 score on a scale
Interval 0.0 to 4.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Shortness of Breath
6-week
3 score on a scale
Interval 1.0 to 4.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Shortness of Breath
3-month
5 score on a scale
Interval 3.0 to 5.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Depression
Baseline
0 score on a scale
Interval 0.0 to 3.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Depression
6-week
3 score on a scale
Interval 1.0 to 5.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Depression
3-month
4.5 score on a scale
Interval 1.0 to 6.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Anxiety
Baseline
0 score on a scale
Interval 0.0 to 5.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Anxiety
6-week
2 score on a scale
Interval 0.5 to 6.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Anxiety
3-month
2.5 score on a scale
Interval 0.0 to 5.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

The ESAS questionnaire is used to rate the intensity of common symptoms including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath; with ratings ranging from 0 (none, best) to 10 (worst).

Outcome measures

Outcome measures
Measure
Intervention
n=25 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Well-being
Baseline
5 score on a scale
Interval 0.0 to 7.0
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Well-being
6-week
4 score on a scale
Interval 3.3 to 6.5
Symptom Burden Assessed by Edmonton Symptom Assessment System (ESAS) Score - Well-being
3-month
3.3 score on a scale
Interval 2.0 to 5.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

Short Form Survey (SF-36) is a 36-item self-reported quality of life that covers 8 domains; score range 0 to 100. Higher score is better quality of life.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Quality of Life Assessed by Short Form Survey (SF-36) Score - Physical Functioning
Baseline
50 score on a scale
Interval 12.5 to 62.5
Quality of Life Assessed by Short Form Survey (SF-36) Score - Physical Functioning
6-week
40 score on a scale
Interval 25.0 to 60.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Physical Functioning
3-month
32.5 score on a scale
Interval 10.0 to 65.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

Short Form Survey (SF-36) is a 36-item self-reported quality of life that covers 8 domains; score range 0 to 100. Higher score is better quality of life.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Quality of Life Assessed by Short Form Survey (SF-36) Score - Role Physical
Baseline
25 score on a scale
Interval 0.0 to 25.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Role Physical
6-week
0 score on a scale
Interval 0.0 to 100.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Role Physical
3-month
0 score on a scale
Interval 0.0 to 75.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

Short Form Survey (SF-36) is a 36-item self-reported quality of life that covers 8 domains; score range 0 to 100. Higher score is better quality of life.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Quality of Life Assessed by Short Form Survey (SF-36) Score - Role Emotional
Baseline
33.33 score on a scale
Interval 0.0 to 100.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Role Emotional
6-week
33.33 score on a scale
Interval 0.0 to 100.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Role Emotional
3-month
16.67 score on a scale
Interval 0.0 to 100.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

Short Form Survey (SF-36) is a 36-item self-reported quality of life that covers 8 domains; score range 0 to 100. Higher score is better quality of life.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Quality of Life Assessed by Short Form Survey (SF-36) Score - Vitality
Baseline
45 score on a scale
Interval 22.5 to 60.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Vitality
6-week
50 score on a scale
Interval 35.0 to 50.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Vitality
3-month
52.5 score on a scale
Interval 50.0 to 65.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who competed the survey at each time point are reported.

Short Form Survey (SF-36) is a 36-item self-reported quality of life that covers 8 domains; score range 0 to 100. Higher score is better quality of life.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Quality of Life Assessed by Short Form Survey (SF-36) Score - Mental Health
Baseline
68 score on a scale
Interval 48.0 to 88.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Mental Health
6-week
68 score on a scale
Interval 46.0 to 92.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Mental Health
3-month
76 score on a scale
Interval 44.0 to 88.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who completed the survey at each time point are reported.

Short Form Survey (SF-36) is a 36-item self-reported quality of life that covers 8 domains; score range 0 to 100. Higher score is better quality of life.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Quality of Life Assessed by Short Form Survey (SF-36) Score - Social Functioning
Baseline
50 score on a scale
Interval 25.0 to 87.5
Quality of Life Assessed by Short Form Survey (SF-36) Score - Social Functioning
6-week
62.5 score on a scale
Interval 25.0 to 75.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - Social Functioning
3-month
50 score on a scale
Interval 25.0 to 75.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who completed the survey at each time point are reported.

Short Form Survey (SF-36) is a 36-item self-reported quality of life that covers 8 domains; score range 0 to 100. Higher score is better quality of life.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Quality of Life Assessed by Short Form Survey (SF-36) Score - Bodily Pain
Baseline
38.75 score on a scale
Interval 10.0 to 67.5
Quality of Life Assessed by Short Form Survey (SF-36) Score - Bodily Pain
6-week
57.5 score on a scale
Interval 42.5 to 67.5
Quality of Life Assessed by Short Form Survey (SF-36) Score - Bodily Pain
3-month
50 score on a scale
Interval 45.0 to 60.0

PRIMARY outcome

Timeframe: Baseline, 6-weeks post intervention, 3 months post intervention

Population: Participants who completed the survey at each time point are reported.

Short Form Survey (SF-36) is a 36-item self-reported quality of life that covers 8 domains; score range 0 to 100. Higher score is better quality of life.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Quality of Life Assessed by Short Form Survey (SF-36) Score - General Health
Baseline
50 score on a scale
Interval 30.0 to 65.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - General Health
6-week
45 score on a scale
Interval 25.0 to 80.0
Quality of Life Assessed by Short Form Survey (SF-36) Score - General Health
3-month
40 score on a scale
Interval 30.0 to 60.0

SECONDARY outcome

Timeframe: 3 months before and after entering the program

Population: One outlier was excluded from the data.

Health-care utilization data will be retrieved from electronic medical records. The study team is defining healthcare utilization by identifying no. of total healthcare utilization, hospitalizations, emergency visits, and critical care admissions. Higher the numbers higher the healthcare utilization.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Health-care Utilization - Total Healthcare Utilization
3 months before entering the program
1 Care utilization events
Interval 1.0 to 2.0
Health-care Utilization - Total Healthcare Utilization
3 months after entering the program
1 Care utilization events
Interval 0.0 to 2.0

SECONDARY outcome

Timeframe: 3 months before and after entering the program

Population: Participants who had data available are reported.

Health-care utilization data will be retrieved from electronic medical records. The study team is defining healthcare utilization by identifying no. of total healthcare utilization, hospitalizations, emergency visits, and critical care admissions. Higher the numbers higher the healthcare utilization.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Health-care Utilization - Emergency Department (ED) Visit s
3 months before entering the program
1 Care utilization events
Interval 1.0 to 2.0
Health-care Utilization - Emergency Department (ED) Visit s
3 months after entering the program
1 Care utilization events
Interval 0.0 to 1.5

SECONDARY outcome

Timeframe: 3 months before and after entering the program

Population: Participants who had data available are reported.

Health-care utilization data will be retrieved from electronic medical records. The study team is defining healthcare utilization by identifying no. of total healthcare utilization, hospitalizations, emergency visits, and critical care admissions.. Higher the numbers higher the healthcare utilization.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Health-care Utilization - Hospitalization
3 months before entering the program
1 Care utilization events
Interval 1.0 to 1.0
Health-care Utilization - Hospitalization
3 months after entering the program
0 Care utilization events
Interval 0.0 to 1.0

SECONDARY outcome

Timeframe: 3 months before and after entering the program

Population: Participants who had data available are reported.

Health-care utilization data will be retrieved from electronic medical records. The study team is defining healthcare utilization by identifying no. of total healthcare utilization, hospitalizations, emergency visits, and critical care admissions. Higher the numbers higher the healthcare utilization.

Outcome measures

Outcome measures
Measure
Intervention
n=24 Participants
The participants received the Care cO-ORDInatioN And sympTom managEment (CO-ORDINATE) intervention, which includes the following four components: i) needs assessment, ii) question prompt list, iii) goals discussion, and iv) symptom assessment and tracking. The intervention comprises one in-person pre-discharge visit by the study team and four follow-up telephone calls conducted at 48 hours, 1 week, 4 weeks, and 6 weeks post-discharge.
Health-care Utilization - Critical Care Admission
3 months before entering the program
1 Care utilization events
Interval 1.0 to 1.0
Health-care Utilization - Critical Care Admission
3 months after entering the program
0 Care utilization events
Interval 0.0 to 0.5

Adverse Events

Intervention

Serious events: 0 serious events
Other events: 0 other events
Deaths: 6 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr.Binu Koirala

Johns Hopkins University School of Nursing

Phone: 707-225-2166

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place