Tele-Health Electronic Monitoring to Reduce Post Discharge Complications and Surgical Site Infections Following Arterial Revascularization With Groin Incision
Phase: NA
Conditions: Peripheral Vascular Disease
Sponsor: CAMC Health System

 
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Telehealth Electronic Monitoring to reduce Post Discharge Complications and  
Surgical Site Infections Following Arterial Revascularization with Groin Incision  
 
 
Registered on ClinicalTrials.gov NCT02767011.   
 
 
This study is funded by West Virginia Clinical and Translational Science Institute 
(WVCTSI) grant U54GM104942 and Charleston Area Medical Center Research 
Institute. The study design, data collection, analysis, interpretation of data, manuscript 
writing; or decision to submit the manuscript for publication was solely the 
responsibilities of the authors.   
 
The study protocol was approved by CAMC/WVU Charleston Division governing 
Institutional Review Board (IRB). 
 
Document Date: 9/28/2016 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Telehealth Electronic Monitoring to reduce Post Discharge Complications and  
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Surgical Site Infections Following Arterial Revascularization with Groin Incision  
1 
 
2 
Albeir Y. Mousa, MD*   
3 
Associate Professor   
4 
Mike Broce, BA**   
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Research Assistant   
6 
Elaine Davis, ED**   
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Care Manager   
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Barbara McKee, RN***   
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Care Manager   
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*Department of Surgery   
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Robert C. Byrd Health Sciences Center/West Virginia University  
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Charleston Area Medical Center, Vascular Center of Excellence  
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3110 MacCorkle Ave., SE, Charleston, WV 25304  
14 
**Center for Health Services and Outcomes Research  
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Charleston Area Medical Center Health Education and Research Institute  
16 
Charleston, WV  
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***Partners in Health Network Charleston, WV  
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Corresponding author:  
20 
Albeir Y. Mousa, MD   
21 
Robert C. Byrd Health Sciences Center/West Virginia University   
22 
Charleston Area Medical Center, Vascular Center of Excellence   
23 
3110 MacCorkle Ave., SE, Charleston, WV 25304   
24 
Phone: 304-388-4875; Fax: 304-3884876; email: amousa@hsc.wvu.edu   
25 
  
26 
This study is funded by West Virginia Clinical and Translational Science Institute 
27 
(WVCTSI) grant U54GM104942 and Charleston Area Medical Center Research 
28 
Institute. The study design, data collection, analysis, interpretation of data, manuscript 
29 
writing; or decision to submit the manuscript for publication was solely the 
30 
responsibilities of the authors.   
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The study is registered on ClinicalTrials.gov NCT02767011.   
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The authors have no other conflicts to report. 
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Tele-Health Electronic Monitoring to reduce Post Discharge Complications and 
1 
Surgical Site Infections Following Arterial Revascularization with Groin Incision  
2 
 
3 
Abstract: 
4 
 
5 
It is intuitive that post discharge surgical complications are associated with 
6 
increased patient dissatisfaction, and directly associated with an increase in medical 
7 
expenditures.  It is also easy to make the connection that many post hospital discharge 
8 
surgical complications including surgical site infections could be influenced or 
9 
exacerbated by patient co-morbidities.  The authors of a recent study reported that female 
10 
gender, obesity, diabetes, smoking, hypertension, coronary artery disease, critical limb 
11 
ischemia, chronic obstructive pulmonary disease, dyspnea, and neurologic disease were 
12 
all of among significant predictors of surgical site infections after vascular reconstruction 
13 
was performed.  The main concern for optimal patient care especially in geographically 
14 
isolated areas of West Virginia is to have early, expeditious, and prompt diagnosis of 
15 
early surgical site infection with subsequent indicated interventions.  This theme will lead 
16 
to patient satisfaction, minimizing third party interventions and decrease the total cost 
17 
associated with these complications.  Nevertheless, it seems reasonable to believe that 
18 
monitoring using telehealth technology and managing the general health care patients 
19 
receive after a hospital vascular intervention will improve overall health and reduce post-
20 
operative complications.    
21 
 
22 
Aims/Objectives:  
23 
 
24 
1. The primary objective of the current project is to compare early and late 
25 
outcomes for patients who receive post discharge health care monitoring 
26 
(which includes using Telehealth electronic monitoring; THEM) to patients 
27 
who receive standard of care (SOC) and routine discharge instructions and no 
28 
monitoring.  
29 
 
30 
Methods:  
31 
 
32 
1. Randomize patients who are scheduled to have revascularization 
33 
interventions with groin incisions to receive either telehealth electronic health 
34 
care monitoring or normal standard of follow-up care.   
35 
2. Follow patients for 4 weeks, record any 30-day hospital readmissions or 
36 
complications.  In addition, have participants complete the follow-up survey 
37 
questionnaires.  
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Background: 
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2 
 
Postoperative hospital readmissions present significant challenges for patients and 
3 
health care systems as well.  There is significant Medicare expenditure devoted to this 
4 
issue.  Although it is intuitive to assume that these issues can be prevented to minimize 
5 
cost, but the problem continues to escalate in many aspects.  A recent report indicated 
6 
that Medicare expenditures were associated with a readmission rate estimated to be $12 
7 
billion per year.1  Another report2 has indicated that about 24% of the entire Medicare 
8 
expenditure is consumed by readmissions.  Ironically, those reports were based on data 
9 
gathered between1974 to 1977, and definitely would be much higher in today 
10 
calculations according to current inflation index in GDP.  As health care professionals, 
11 
we should be aware of all ongoing ramifications associated with readmissions, as the 
12 
integral scope of proper patient care is under scrutiny with all its related issues such as, 
13 
hospital reimbursement, physician credentialing process and regulation, referral pattern 
14 
and eventually educational enterprises.3 
15 
 
16 
Surgical Site Infections Following Arterial Revascularization with Groin Incision  
17 
 
18 
 
19 
 
Vascular surgery especially arterial revascularizations with groin incisions 
20 
(ARGI) has always been associated with the potential of higher rates of readmission 
21 
pertaining to high-risk patients with multiple co-morbidities such as diabetes, cardiac 
22 
issues and poor general nutrition.  These types of issues are more demanding in 
23 
geographical areas such as rural West Virginia where easy access to medical attention is 
24 
not available.  In most cases, 30 day-readmissions are considered to be in-hospital 
25 
complications.  However, some authorities have suggested that readmissions after 
26 
vascular interventions are really measures of post discharge complications rather than in-
27 
hospital complications.3-8  Most U.S hospitals are currently in full compliance with the 
28 
Surgical Care Improvement Project (SCIP).  Unfortunately, compliance with these 
29 
processes has not yet directly been associated with reduced SSI rates.9, 10  In addition, 
30 
reports of 30-day readmission rates for vascular surgery patients are very high and it may 
31 
vary from 11 to 25%.1, 8 
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33 
 
Identifying patients with higher rates of readmission after discharge is of essence 
34 
in order to pay more attention or even to deploy a system to monitor them closely.  In one 
35 
study,11 patients with a positive clinical culture obtained more than 48 hours after hospital 
36 
admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33-1.46) after 
37 
adjusting for other co-morbidities.  Another review indicated that SSIs may develop in 
38 
10% of the 3,663 patients who underwent an inpatient general surgical procedure.  It has 
39 
been reported that diagnosis of SSI after discharge was also associated with a high 
40 
readmission rate despite occurring in healthier patients.  It has been proposed that 
41 
discharge specific instructions related to wound infections along with a wound 
42 
surveillance in-clinic visit within the first week may result in a decreased readmission 
43 
rate.7  Gohil et al assessed 30-day readmission rates from 323 hospitals and reported that 
44 
infection-related readmissions accounted for 28% of all readmissions.  The same study 
45 
reported that academic hospitals had higher all-cause and infection-related readmission 
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rates.12  
1 
 
 
2 
 
The thought of reducing readmission and infection rates has been energized by the 
3 
recent policy proposals suggested by the Medicare Payment Advisory Commission to 
4 
lower average per-case reimbursements to hospitals with high (risk-adjusted) rates of re-
5 
hospitalizations.  It is important to identify high-risk patients in order to be more focused 
6 
and to incorporate procedures to identify early signs of infection.  This approach of 
7 
increased outpatient support has been proven to be cost effective.2 Some researchers have 
8 
developed a scoring system to accurately identify patients at high risk for 30-day 
9 
unplanned readmissions and suggested this could help direct discharge and home health 
10 
care resources to patients, which ultimately could be used to reduce readmissions and 
11 
improving efficiency.8  Gibson et al reported that diagnosis of surgical site infection (SSI) 
12 
after discharge is associated with a high readmission rate despite occurring in healthier 
13 
patients.7  The authors of a recent study reported that female gender, obesity, diabetes, 
14 
smoking, hypertension, coronary artery disease, critical limb ischemia, chronic 
15 
obstructive pulmonary disease, dyspnea, and neurologic disease were all of among 
16 
significant predictors of SSI after vascular reconstruction was performed.13  Another 
17 
important potential impact of telehealth technology is that it may minimize the burden 
18 
and cost of 3rd party home visits to evaluate wounds or provide treatment.  Currently, 
19 
many interventions of vascular surgery require postoperative visiting nursing service 
20 
(VNS) to evaluate wound or treatment at home.  The home visit approach utilizes 
21 
significant resources to achieve its target.  As part of the main objectives of telehealth 
22 
technology, we believe that our suggested approach will limit not only the number but 
23 
also the frequency of VNS. In addition it may even supersede VNS as it provides to some 
24 
extent more continuous and more objectives measures to provide a better follow up to our 
25 
patients after discharge.  
26 
 
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In conclusion, it seems reasonable to believe that monitoring using telehealth 
28 
technology and managing the general health care patients receive after a hospital vascular 
29 
ARGI intervention will improve overall health, patient care and will reduce post 
30 
operative complications.  Our project will be conducted to directly give more and 
31 
continuous attention to postoperative period after hospital discharge. We believe that 
32 
early readmission is a “failed discharge” as has suggested by others.  This matter is of 
33 
great interest particularly to our specialty. 
34 
  
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Objectives 
37 
 
The primary objective of the current project is to compare outcomes for patients 
38 
who receive post discharge health care monitoring (which includes using Telehealth 
39 
electonic monitoring; THEM) to patients who receive standard of care (SOC) and routine 
40 
discharge instructions and no monitoring.  
41 
Outcomes 
42 
 
The primary outcomes include 30-day readmissions, post-operative complications 
43 
and access site/wound infections.  Secondary outcomes will include a pre and post 
44 
surgery quality of life measures (SF-8) and patient satisfaction (>30-day) along with an 
45 
occurrence of any 30-day stroke, MI or death. 
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1 
 
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Study hypotheses: 
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1. A smaller percentage of THEM patients will require a 30-day unplanned 
5 
readmission. 
6 
2. A smaller percentage of THEM patients will develop a SSI. 
7 
3. THEM patients will report greater post discharge satisfaction and higher 
8 
quality of life measures. 
9 
 
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Significance: 
11 
 
12 
1. Information and results obtained from this study may suggest additional post 
13 
discharge treatment approaches which in turn could lower 30-day 
14 
readmissions and complications for patients undergoing surgery.  
15 
  
16 
2. Likewise, information and results obtained from this study could be used to 
17 
help promote greater patient satisfaction and quality of life measures.   
18 
 
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3. This approach may impact some direct cost pertaining to post-discharge 
20 
follow-up as visiting nurse services. THEM approach will provide a direct, 
21 
measurable, specific tool to provide therapy related information to the treating 
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physician during post-discharge period. 
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Study Design: 
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The current study is designed to be a prospective, randomized, open-label, single-
28 
center with blinded endpoints (PROBE) study.14 More specifically, it is designed to test 
29 
the hypothesis that Tele-health monitoring will decrease 30-day readmission and 
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complication rates.  Patients with planned vascular ARGIs will be consented for possible 
31 
inclusion.  Patients who give their consent will be enrolled and randomly assigned to one 
32 
of the two treatment arms: 1) standard of care (SOC) or 2) Tele-health electronic 
33 
monitoring (THEM) using TeleMed 2020 home health monitoring system.   
34 
The primary endpoints will be measured as simply the occurrence or not of any 
35 
unplanned 30-day readmission and/or complication (0/1).  Patients in the intervention 
36 
group (THEM) will receive a tablet computer and home monitoring medical devices with 
37 
sensors to transmit the information to a central website that will be monitored by care 
38 
managers.  Medical devices will include weight scales, blood pressure cuffs and oxygen 
39 
saturation monitors.  Clinical care mangers will remotely monitor the patients and all 
40 
electronic readings.  Clinical care managers will call or send electronic  messages to the 
41 
patients based on alerts generated by the tele-health monitoring system.     
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43 
Sample: 
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1 
The population for this study will be patients with any planned vascular procedures with 
2 
cut-down access to the groin and will be treated by one of the Vascular Surgeons in the 
3 
Vascular Center of Excellence (VCOE).  
4 
 
5 
Sample Size: 
6 
The sample size was estimated based on the readmission rates from a previous research 
7 
study.  An overall sample size of 200 subjects will have 80% power to detect a reduction 
8 
in the 30-day infection/readmission rate from ~12 in the SOC group to ~2% in the THEM 
9 
group using a 2-sided α of 0.05.  We expect a 10% drop-out rate and thus plan to enroll 
10 
110 patients in each group (N=220 overall).   
11 
 
12 
 
13 
Inclusion/exclusion criteria:   
14 
Patients meeting the inclusion criteria, which is any planned vascular procedures with 
15 
cut-down access to the groin and treated by one of the Vascular Surgeons in the Vascular 
16 
Center (VCOE) will be consented and enrolled.  Patients will be excluded for any of the 
17 
following reasons (1) do not plan to do follow-up visit at the VCOE; (2) inability to sign 
18 
or understand the consent form; (3) do not have home internet service with WIFI or live 
19 
outside of the provided cell coverage area (cell coverage will be provided for patients 
20 
without internet WIFI).  Informed consent will be obtained research coordinator; eligible 
21 
patients will be randomly assigned to either the treatment group (THEM) or the control 
22 
group (SOC).     
23 
 
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25 
Randomization: 
26 
The randomization will be done centrally using a computer containing a SPSS algorithm.  
27 
The randomized list will be placed in 220 envelopes and labeled 1 through 220. After 
28 
randomization and necessary medical procedures, but before discharge each patient 
29 
depending on treatment assignment will receive either the home monitoring equipment 
30 
with instruction for those in the treatment group (THEM) or normal discharge 
31 
instructions for the control group (SOC).   
32 
 
33 
Patients in the intervention group will receive a tablet computer and home monitoring 
34 
medical devices with sensors to transmit the information to a central website that will be 
35 
monitored by care managers.  The TeleMed 2020 electronic home health monitoring 
36 
system will be used to provide constant surveillance of THEM patients.  In addition, the 
37 
tablets will have the ability to send a high resolution photograph of wound if needed.  
38 
Medical devices will include weight scales, blood pressure cuffs, thermometers and 
39 
oxygen saturation monitors..  Clinical care mangers will remotely monitor the health of 
40 
patients by viewing all electronic readings.  Study care managers will call or send 
41 
electronic messages to the patients based on alerts generated by the tele-monitoring 
42 
system.  The main focus of this approach is to have a direct, specific, objective and 
43 
measurable assessment of any early wound infection after lower extremity 
44 
revascularization.  The care manager will make direct electronic communication as to the 
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appearance of the access wound and if needed request that a picture be sent for 
1 
observation.   
2 
   
3 
TeleMed 2020 
4 
 
5 
Bloomberg Business Company Overview of TeleMed 2020, Inc. 
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7 
Company Overview 
8 
TeleMed 2020, Inc. owns and operates a cloud-based SaaS solution for remote patient 
9 
monitoring. The company allows clinician scheduling and ongoing patient capture and 
10 
sharing of critical information yielding earlier and more active care plan management. 
11 
The company is based in Indianapolis, Indiana. 
12 
 
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http://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapid=310873357 
14 
 
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For the THEM group, the care manager will: 
17 
 
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1. Monitor patient vital signs: daily weight, blood pressure, pulse, , oxygen 
19 
saturation and temperature  
20 
2. Ask about the description of the postoperative wound site: including any 
21 
surrounding erythema, discharge, wound dehiscence and healing.  If necessary, 
22 
ask for a picture of the wound site to be sent. A transmitted photograph of the 
23 
wound condition may augment amount of knowledge available to clinical care 
24 
management team.  
25 
3. Complete a target organ evaluation: which means to evaluate the bypass and this 
26 
will include general feeling, pain (location, degree, type and relieving elements). 
27 
4. Assess compliance with the discharge medications. 
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Early signs of infection would include, but not be limited to fever, tachycardia, 
31 
discharge, erythema, wound dehiscence, and pain.  All of these will be evaluated via 
32 
telecommunication tools by the care manager and if needed immediately discussed with 
33 
supervising physician.  In addition, the patient, if needed, will be scheduled for an early 
34 
office visit and/or re-hospitalization. 
35 
 
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For the SOC group, the care manager will follow the current standard of care. 
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Procedure: 
40 
PRE-TREATMENT: 
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 Patients will be identified by the Vascular Surgeon and scheduled for the 
42 
procedure. 
43 
 Study coordinator will review patient scheduling records to identify 
44 
potential study participants. 
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 The study coordinator will explain the research study and the informed 
1 
consent with the patient prior to the surgical intervention. 
2 
 The patient upon appropriate consent signs and dates the consent form and 
3 
the HIPPA authorization form, which is attached to the consent form. 
4 
 Patient upon informed consent is randomized to either receive the treatment 
5 
(THEM) or to the SOC control group (SOC).     
6 
 Complete a pre-treatment SF-8 and baseline history form. 
7 
 
8 
Quality of life measure 
9 
 
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The SF-8™ Health Survey is a brief and comprehensive quality of life population survey.  
11 
It has only eight questionnaire items, and by design according to the company’s website 
12 
“was constructed to replace the SF-36® and SF-12® in population health surveys in the 
13 
U.S. and internationally.  Accordingly, it has been translated and linguistically validated 
14 
for use in more than 30 countries and languages using IQOLA Project methods. It has 
15 
been adopted by federal agencies (e.g., the DOD), leading polling organizations (e.g., the 
16 
Roper-Starch Worldwide Health Report), and industry sponsors of clinical trials and 
17 
effectiveness research (e.g., Glaxo Smith Kline, Johnson & Johnson, and Searle).”  In 
18 
addition, the validation and norming measures of the SF-8™ Health included the general 
19 
population as well as many subgroups of subjects with co-morbidities such as depression 
20 
and diabetes.  The SF-8™ is a very sensitive test that has both test/retest reliability as 
21 
well as the ability to detect change of time.   The scoring of the SF-8™ produces two 
22 
summary scores.  One for the physical (PCS) and one for the mental dimension (MCS).  
23 
It also provides the same 8 subscale scores for each dimension as the SF-36.    
24 
 
25 
Vascular Intervention: 
26 
All patients will receive their planned and scheduled procedures.   
27 
 
28 
Follow-Up Protocol: 
29 
After 2-4 weeks, all patients will have a follow-up visit scheduled at the VCOE 
30 
clinic.  Follow-up will include physical exam including a routine visual 
31 
inspection of access site wound and comments will be collected.  All patients 
32 
will complete a second SF-8 survey form and a patient satisfaction survey.  If 
33 
follow-up visit is less than 30 days, then a member of the study team will call 
34 
patients and obtain SF-8, satisfaction survey and follow-up form.   
35 
 
36 
Data Collection: 
37 
Will include (see appendix): 
38 
1) Signed consent forms 
39 
2) Enrollment and demographics form 
40 
3) SF-8 survey 
41 
4) Patient satisfaction survey 
42 
5) 4 week follow-up form 
43 
 
44 
Schedule of Events 
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Information: 
SOC 
THEM 
Sign Informed Consent 
Pre-Intervention 
Pre-Intervention 
Randomization 
Pre-Intervention 
Pre-Intervention 
Pre-treatment  
SF-8 survey 
SF-8 survey 
Equipment & instructions 
At discharge 
At discharge 
Follow Up: 
  
  
Special issue follow-up 
Patient initiated 
Patient or monitor initiated 
Routine follow-up exam 
2-4 weeks 
2-4 weeks 
SF-8 survey 
SF-8 survey 
Satisfaction survey 
Satisfaction survey 
Follow-up form 
Follow-up form 
Debriefing 
Debriefing 
 
1 
SOC = Standard of Care 
2 
THEM = Tele-Health Electronic Monitoring 
3 
 
4 
 
5 
Statistical Analysis: 
6 
 
7 
 
All analyses will be based on intention-to-treat (ITT) analyses.  However, if 
8 
possible we will sub-analyze the data on a per-protocol basis as well.  Descriptive 
9 
statistics will be expressed in terms of frequencies, percentages, or means + standard 
10 
deviation (SD).  Categorical variables will be tested by chi-square or Fisher exact tests 
11 
and continuous variables will be tested by student t-test or paired t-test for pre/post 
12 
measures, where deemed appropriate.  Survival and freedom from event curves such as 
13 
freedom from re-admission will be created using the Kaplan Meier method, compared by 
14 
the Log Rank test, and graphically presented using life tables.  All probability values will 
15 
be 2 sided and ‘p’ values <0.05 will be considered significant.  Statistical analyses will be 
16 
performed using SPSS version 19.0 for Windows.  This study will be registered at 
17 
ClinicalTrials.gov.   
18 
 
19 
End Points: 
20 
 
21 
 
The primary outcomes include 30-day readmissions, post-operative complications 
22 
and access site/wound infections.   
23 
 
24 
 
Secondary outcomes will include a pre and post-surgery quality of life measures 
25 
(SF-8), patient satisfaction (>30-day) and number of VNS visits along with an occurrence 
26 
of any 30-day stroke, MI or death. 
27 
 
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Definitions: 
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1 
 
Event-free survival will be defined as the freedom from unplanned 30-day 
2 
readmission and/or 30-day access site wound infection.   
3 
 
4 
Human Subjects 
5 
Recruitment Method(s) 
6 
 
7 
 
The current study protocol received approval from our local institutional review 
8 
board.  The study group participants will sign consent papers on admission to the 
9 
vascular lab when the patient presents for pre-procedure evaluation.  The study care 
10 
manger will identify potential study participants, and provide information about the 
11 
study.  Study staff will be trained and knowledgeable on the research protocol.  This 
12 
study will not offer any direct benefit for the study participants.  Staff will not begin 
13 
consenting patients until they have completed this training and are in compliance with 
14 
any pertinent trainings offered by Research and Grants.   
15 
 
16 
Payment/Costs of Testing: 
17 
 
18 
 
Patients enrolled in both study comparison groups (THEM and SOC) will not 
19 
incur additional expenses as a due to their participation in this study.  Normal standard of 
20 
care will be provided to the participants in the SOC group, while the members of THEM 
21 
group will receive enhanced care management.  The patient’s insurance or the patient will 
22 
not be billed for any of the care management or Tele-health monitoring.        
23 
 
24 
 Risk and Benefits:  
25 
 
26 
 
There are no known risks or benefits to the study patients.  Data collection takes 
27 
place utilizing existing data that has been acquired during the delivery of routine medical 
28 
care 
29 
 
30 
SIDE EFFECTS 
31 
 
32 
To date there are no know or expected side effects.  Should other unknown risks 
33 
become available to the researchers; patients will be informed as soon as possible. 
34 
 
35 
 
36 
Adverse reactions 
37 
 
38 
To date there are no know or expected side effects.  Should other unknown risks    
39 
become available to the researchers; patients will be informed as soon as possible. 
40 
 
41 
Confidentiality of Records:  
42 
 
43 
 
Records will be kept on all study participants according to standard routine 
44 
procedures.  However, additional study variables will be collected.  Electronic and data 
45 
collection sheets will be kept in strict confidence.  Data collection sheets will be kept in a 
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locked area.  Electronic data will reside on a secure CHERI server and will only be 
1 
accessible by appropriate research staff members.   
2 
 
3 
Compensation:  
4 
Participation in this research study is strictly voluntary and participants will not be 
5 
reimbursed or paid for their participation.   
6 
 
7 
Debriefing:  
8 
Participants will be treated with the same standard of care as all other patients.    
9 
 
10 
 Interventions: 
11 
 
12 
 
Participants will follow the same standard of care as other patients requiring 
13 
treatment.   If a study participant has any side effects, the patient will be evaluated by 
14 
their physician and a decision to continue or stop treatment will be made. 
15 
 
16 
Investigator Qualifications:  
17 
 
18 
Albeir Mousa, MD., FACS, RPVI, MPH, MBA 
19 
Associate Professor, Department of Surgery 
20 
Vascular and Endovascular Surgery Division 
21 
West Virginia University 
22 
3110 MacCorkle Ave SE 
23 
Charleston, WV 25304 
24 
Office: 304-388-4886 
25 
Pager: 304-330-7177 
26 
Fax: 304-388-4876 
27 
 
28 
 
29 
 
30 
Other Participants:  
31 
Mike Broce BA will provide data analysis and interpretation support; he is an employee 
32 
of the CAMC Health Education and Research Institute.  
33 
 
34 
A .5 FTE nurse will serve as study coordinator/clinical care manager.  
35 
 
36 
 
 
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References: 
1 
 
2 
1. 
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among 
3 
patients in the Medicare fee-for-service program. N Engl J Med. 
4 
2009;360(14):1418-28. 
5 
2. 
Anderson GF, Steinberg EP. Hospital readmissions in the Medicare 
6 
population. N Engl J Med. 1984;311(21):1349-53. 
7 
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