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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RECRUITING
NA
650 participants
INTERVENTIONAL
2024-08-26
2026-06-26
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
SINGLE
Study Groups
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Facility-based
Facility based post acute care at a skilled nursing facility, as is the standard care model.
No interventions assigned to this group
Home-based
Home-based Post-Acute Care
Sub-Acute Rehab at Home
Patients randomized to the intervention group will receive skilled nursing and rehabilitative care at home upon discharge from the hospital, or when eligible for skilled-nursing facility care when requiring a step up in services at home. Home care will be delivered and overseen by a multidisciplinary clinical team, which will develop individualized care plans based on diagnosis, specific rehabilitation objectives, and broader goals of care.
Interventions
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Sub-Acute Rehab at Home
Patients randomized to the intervention group will receive skilled nursing and rehabilitative care at home upon discharge from the hospital, or when eligible for skilled-nursing facility care when requiring a step up in services at home. Home care will be delivered and overseen by a multidisciplinary clinical team, which will develop individualized care plans based on diagnosis, specific rehabilitation objectives, and broader goals of care.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Admitted to an inpatient unit OR receiving home health and requiring an escalation to skilled-nursing facility care
* Require post-acute care in a skilled nursing facility based on the clinical inpatient team's assessment (or, if the participant is coming from home, based on the home health team's assessment)
* Pass the home readiness assessment
* Reside within Greater Worcester or Greater Springfield
Exclusion Criteria
* Inability for patient or their proxy to provide informed consent for the study
* Requires long-term care
* Requires palliative or hospice care
* On active chemotherapy
* Post-transplant surgery
* Requires hemodialysis
* Requires radiation therapy
* Requires two-person assist or mechanical lift
* Expresses unwillingness to be randomized to SNF OR SNF at Home care
* Considered clinically inappropriate by SNF at Home clinical team
18 Years
ALL
No
Sponsors
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Baystate Health
OTHER
UMass Memorial Health
OTHER
Massachusetts Executive Office of Health and Human Services (EOHHS)
UNKNOWN
University of Massachusetts, Worcester
OTHER
Responsible Party
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Apurv Soni
Assistant Professor
Principal Investigators
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Principal Investigator
Role: PRINCIPAL_INVESTIGATOR
University of Massachusetts, Worcester
Locations
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Baystate Medical Center
Springfield, Massachusetts, United States
UMass Memorial Medical Center
Worcester, Massachusetts, United States
Countries
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Central Contacts
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Facility Contacts
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Peter Lindenauer, MD
Role: primary
Apurv Soni, MD, PhD
Role: primary
Other Identifiers
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STUDY00001862
Identifier Type: -
Identifier Source: org_study_id
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