Expanding Access to Comprehensive Geriatrics Care Via Telehealth

Study Overview
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Brief Summary
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The overall objective of the TeleGRACE project is to improve the care and outcomes of older Veterans with a recent inpatient stay by expanding access to the evidence-based GRACE program, by evaluating a telehealth implementation.

Detailed Description
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The TeleGRACE evaluation will focus on three primary aims and a secondary aim: Primary Aim 1: To examine the effectiveness of the TeleGRACE program, the investigators designed a randomized controlled implementation trial (RCT) powered for the primary outcome of 90-day all-cause mortality. The investigators will also examine its effectiveness for the secondary outcomes including 90-day readmissions, 1-year ED utilization (VA and non-VA), 1-year all-cause readmissions, 1-year mortality, as well as patient, caregiver, and staff satisfaction. The investigators hypothesize that patients who receive TeleGRACE will have lower 90-day mortality than patients in usual care. Primary Aim 2: to examine the implementation of the TeleGRACE program. The implementation strategy is reflecting & evaluating. Implementation outcomes are based on the REAIM framework and include reach, efficacy (Aim 1), and implementation (total number of Veterans served, fidelity). Primary Aim 3: to conduct a business-case analysis (BCA). The business case analysis will calculate the net financial savings or loss for TeleGRACE as the difference in the overall intervention costs and savings due to downstream benefits for patients receiving TeleGRACE versus usual care controls.

Official Title
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Expanding Access to Comprehensive Geriatrics Care Via Telehealth (QUE 20-010)

Conditions
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Geriatric Syndrome

Intervention / Treatment
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* Other: TeleGRACE


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veterans discharged from the Indianapolis VA medical center (VAMC) for an medical/surgical diagnosis (excludes substance use disorder-related admissions; excludes planned admissions) within the prior week Age 70 years Not enrolled in home-based primary care (HBPC) Not enrolled in hospice Not in dialysis Primary care visit within VA in the prior 2 years Not residing in nursing home, skilled nursing facility, or CLC. Living >20 miles but <60 miles from the Indianapolis VAMC facility CAN score 95th percentile for mortality or missing CAN score Discharged from the hospital alive Exclusion Criteria: Patients who have been randomized to the control arm after their index hospitalization who become readmitted to the hospital may not be re-randomized. By definition, GRACE patients are not eligible for TeleGRACE due to the drive distance >20 miles from the Indianapolis VAMC Enrolled in home-based primary care (HBPC) Enrolled in hospice Dialysis (hemodialysis or peritoneal dialysis) Residing in nursing home, skilled nursing facility, or CLC. Living <20 miles or 60 miles from the Indianapolis VAMC facility

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TeleGRACE<br>Patients receive a virtual home visit and care from the GRACE team | Other: TeleGRACE<br>* Patients receive a virtual home visit and care from the GRACE team<br>|
| No Intervention: Usual Care<br>Patients receive usual care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 90-day All-cause Mortality | The primary outcome is 90-day all-cause mortality measured from the date of discharge from the index hospitalization. | 90-days from discharge from the index hospitalization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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comprehensive geriatrics assessment, telehealth, home visit