ED-LEAD: Emergency Departments Leading the Transformation of Alzheimer's and Dementia Care
NCT ID: NCT06079203
Last Updated: 2025-09-10
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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NOT_YET_RECRUITING
NA
19200 participants
INTERVENTIONAL
2025-09-02
2028-08-31
Brief Summary
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
HEALTH_SERVICES_RESEARCH
NONE
Study Groups
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No intervention
No intervention, serving as a usual care control group
No interventions assigned to this group
Single intervention: Emergency Care Redesign (ECR)
Emergency Care Redesign (ECR)
Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift
CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond
Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services
Single intervention: Nurse-led Telephonic Care (NLTC)
Nurse-led Telephonic Care (NLTC)
Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call \~30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers
Single intervention: Community Paramedic-led Transitions Intervention (CPTI)
Community Paramedic-led Transitions Intervention (CPTI)
Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within \~5 days of index ED visit. One home visit and three telephone encounters over 30 days
Two intervention: ECR and NLTC
Emergency Care Redesign (ECR)
Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift
CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond
Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services
Nurse-led Telephonic Care (NLTC)
Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call \~30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers
Two interventions: ECR and CPTI
Emergency Care Redesign (ECR)
Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift
CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond
Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services
Community Paramedic-led Transitions Intervention (CPTI)
Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within \~5 days of index ED visit. One home visit and three telephone encounters over 30 days
Two interventions: NLTC and CPTI
Nurse-led Telephonic Care (NLTC)
Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call \~30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers
Community Paramedic-led Transitions Intervention (CPTI)
Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within \~5 days of index ED visit. One home visit and three telephone encounters over 30 days
All interventions: ECR, NLTC, and CPTI
Emergency Care Redesign (ECR)
Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift
CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond
Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services
Nurse-led Telephonic Care (NLTC)
Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call \~30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers
Community Paramedic-led Transitions Intervention (CPTI)
Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within \~5 days of index ED visit. One home visit and three telephone encounters over 30 days
Interventions
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Emergency Care Redesign (ECR)
Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift
CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond
Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services
Nurse-led Telephonic Care (NLTC)
Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call \~30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers
Community Paramedic-led Transitions Intervention (CPTI)
Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within \~5 days of index ED visit. One home visit and three telephone encounters over 30 days
Eligibility Criteria
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Inclusion Criteria
* have at least one ICD-10 visit diagnoses for Alzheimer's Disease or Alzheimer's Disease Related Dementias (AD/ADRD) from an inpatient or outpatient encounter within the last 3 years of the ED visit and are discharged (observation patients included)
Exclusion Criteria
66 Years
ALL
No
Sponsors
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National Institute on Aging (NIA)
NIH
NYU Langone Health
OTHER
Responsible Party
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Principal Investigators
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Joshua Chodosh, MD
Role: PRINCIPAL_INVESTIGATOR
NYU Langone Health
Locations
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NYU Langone Health
New York, New York, United States
Countries
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Central Contacts
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Other Identifiers
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23-00516
Identifier Type: -
Identifier Source: org_study_id
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