Testing the Re-Engineered Hospital Discharge

Study Overview
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Brief Summary
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The purpose of this study is to determine if the Re-Engineered Discharge will decrease rehospitalization rates and adverse events of patients leaving Boston Medical Center.

Detailed Description
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This project responds to the problems of non-standardized care and discontinuity at hospital discharge. Post-discharge adverse events are common and have been well documented. However, to date, there are no studies demonstrating the effectiveness of any procedures or tools designed to reduce them. This work builds on our Safe Practices Implementation Challenge Grant in which we developed the Reengineered Hospital Discharge tool, a set of 10 discrete, mutually reinforcing components. Hypotheses: The newly designed Re-engineered Hospital Discharge intervention will (1) reduce the percentage of patients experiencing a post-discharge adverse event, and (2) reduce subsequent hospital utilization (emergency department visits and rehospitalization) within 30 days following hospital discharge. Population Studied: Patients from a network of Community Health Centers discharged from a general medical service at an urban hospital. The subjects studied represent a low-income, ethnically diverse urban population. This study meets AHRQ guidelines for the inclusion of priority populations in research. Methods: 432 adult patients admitted to the general medical service of Boston Medical Center will be enrolled and randomized to (1) those receiving routine discharge as defined by our Process Map (Control Group); and (2) those receiving our Re-engineered Hospital Discharge intervention, a set of 10 discrete, mutually reinforcing components provided by a Discharge Advocate and re-enforced by a telephone call 2-4 days after discharge by a clinical pharmacist (Intervention Group). Outcome Measures: The primary patient centered outcomes are: the combined 30-day subsequent hospital utilization (readmission and emergency department use), and health status as measured by the SF-12. Process outcomes include the number and severity of the adverse events related to the discharge 30 days after discharge. Although not a primary outcome, an economic analysis will be completed. Expected Results: This project will provide valuable information about whether the Re-Engineered Discharge will reduce adverse events related to discharge and decrease subsequent hospital utilization. Deliverables/Dissemination: An advisory committee of senior Boston Medical Center leaders will oversee the project and, if proven effective, will implement the intervention throughout our Academic Medical Center. The Re-engineered Hospital Discharge tool will be widely generalizable and widely disseminated.

Official Title
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Testing the Re-Engineered Hospital Discharge

Conditions
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All

Intervention / Treatment
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* Behavioral: Re-Engineered Hospital Discharge


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The Project Director will meet with the subject to determine if the patient meets inclusion or exclusion criteria. Inclusion criteria include are patients who: are over 18 years old; are to be discharged to a community, non-institutionalized setting; report that they desire to be hospitalized in the future if there is a clinical need; and are admitted to Firm B of the BMC Inpatient Service. Exclusion Criteria: admitted to non-general Medical services at BMC (e.g., orthopedic surgery, obstetrics and gynecology, otolaryngology, general surgery, or psychiatry); requiring hospice, nursing home or other institutional settings upon discharge, who die during the admission, subjects who speak languages other than English; those who indicate that they have no access to a telephone or unable to give a contact telephone number; and those not competent to sign informed consent.

Ages Eligible for Study
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Minimum Age: 18 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Re-engineered hospital discharge<br>Participants received the Re-Engineered Hospital Discharge, a set of 11 discrete, mutually reinforcing components provided by a Discharge Advocate and re-enforced by a telephone call 2-4 days after discharge by a clinical pharmacist. | Behavioral: Re-Engineered Hospital Discharge<br>* The Re-engineered Hospital Discharge (Project RED) intervention provides a set of 11 discrete, mutually reinforcing components provided by a Discharge Advocate and re-enforced by a telephone call after discharge by a clinical pharmacist.<br>* Other names: RED;|
| No Intervention: Standard hospital discharge<br>Participants received the routine, standard hospital discharge. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Number of Rehospitalizations (Emergency Department Visits Plus Hospital Admissions) in the 30 Days After Discharge. | The total number of rehospitalizations (emergency department visits plus hospital admissions) in the 30 days after discharge, compared across study arms. Participants could have more than one rehospitalization in this period; all rehospitalizations for each were counted, making the unit of measure the rehospitalizations and not the participants. | 30 days after discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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rehospitalization, readmission, adverse events, discharge