Improving Post-Hospitalization Transition Outcomes through Accessible Health Information Technology and Caregiver Support: Protocol for a Randomized Controlled Trial
|John D Piette1,2,3*, Dana Striplin1,2, Nicolle Marinec1,2, Jenny Chen1,2, Lynn A Gregory1,2, Denise L Sumerlin1,2, Angela M DeSantis1,2, Carolyn Gibson1,2, Ingrid Crause1,2, Marylena Rouse1,2 and James E Aikens4|
|1Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA|
|2Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA|
|3Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA|
|4Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA|
|Corresponding Author :||John D Piette
Center for Managing Chronic Disease
University of Michigan School of Public Health
1415 Washington Heights, Ann Arbor, MI, 48109
E-mail: [email protected]
|Received: July 25, 2015; Accepted: September 26, 2015; Published: October 03, 2015|
|Citation: Piette JD, Striplin D, Marinec N, Chen J, Gregory LA, et al. (2015) Improving Post-Hospitalization Transition Outcomes through Accessible Health Information Technology and Caregiver Support: Protocol for a Randomized Controlled Trial. J Clin Trials 5:240. doi:10.4172/2167-0870.1000240|
|Copyright: © 2015 Piette JD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Objective: The goal of this trial is to evaluate a novel intervention designed to improve post-hospitalization support for older adults with chronic conditions via: (a) direct tailored communication to patients using regular automated calls post discharge, (b) support for informal caregivers outside of the patient’s household via structured automated feedback about the patient’s status plus advice about how caregivers can help, and (c) support for care management including a web-based disease management tool and alerts about potential problems.
Methods: 846 older adults with common chronic conditions are being identified upon hospital admission. Patients are asked to identify a “CarePartner” (CP) living outside their household, i.e., an adult child or other social network member willing to play an active role in their post-discharge transition support. Patient-CP pairs are randomized to the intervention or usual care. Intervention patients receive automated assessment and behavior change calls, and their CPs receives structured feedback and advice via email and automated calls following each assessment. Clinical teams have access to assessment results via the web and receive automated reports about urgent health problems. Patients complete surveys at baseline, 30 days, and 90 days post discharge; utilization data is obtained from hospital records. CPs, other caregivers, and clinicians are interviewed to evaluate intervention effects on processes of self-care support, caregiver stress and communication, and the intervention’s potential for broader implementation. The primary outcome is 30-day readmission rates; other outcomes measured at 30 days and 90 days include functional status, self-care behaviors, and mortality risk.
Conclusion: This trial uses accessible health technologies and coordinated communication among informal caregivers and clinicians to fill the growing gap between what discharged patients need and available resources. A unique feature of the intervention is the provision of transition support not only for patients but also for their informal caregivers.