Reducing Hospital Readmissions in Patients With Depressive Symptoms

Study Overview
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Brief Summary
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Project Re-Engineered Discharge (Project RED) has previously demonstrated that patients who received the RED were 30% less likely than patients receiving usual care to access inpatient or emergency services within 30 days of discharge. In this project, the investigators add a new dimension to RED by integrating screening, referral and treatment for depression into the original RED intervention and determining if this enhanced intervention increases the effectiveness of RED in preventing readmissions and controlling costs in the 180 days after discharge for patients with signs of depression.

Official Title
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Reducing Hospital Readmission Among Medical Patients With Depressive Symptoms

Conditions
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Depression

Intervention / Treatment
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* Other: RED-D Care Management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 18 years of age Admitted to any Boston Medical Center inpatient service or for observation Screen positive for depressive symptoms (Patient Health Questionnaire - 2 >/= 3) Speaks English with health care providers Has access to a telephone Live in the Boston area and don't plan on leaving the Boston area for more than 2 weeks in the next 6 months Screen positive for depressive symptoms (PHQ -9 >/= 10) Exclusion Criteria: Has plans for inpatient rehabilitation, nursing home, or other institutional settings after discharge. Suicidal precautions Sickle Cell Crisis (SCC) Alcohol and/or drug dependence Diagnosis of Bipolar Disorder, Schizophrenia or other Psychotic Disorder In police custody

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: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: RED-D Care Management<br>Patients randomized to receive the Intervention work with a RED-D Care Manager post-discharge. The Care Manager meets with the patient in the hospital, prior to discharge, and post-discharge via weekly phone calls. Patients have access to a range of treatment options, overseen by the Care Manager, including: (1) medication; (2) cognitive behavioral therapy (CBT); (3) complementary and alternative medicine (CAM) information and referral; (4) Self-help, such as reading a book, making a change in diet and/or exercise in order to improve mood; (5) active surveillance; and (6) any combination of 1, 2, 3, 4 & 5. | Other: RED-D Care Management<br>* The Case Management intervention will continue for 12 weeks post-discharge (from the index admission).<br>|
| No Intervention: RED and Behavioral Health Referral<br>Patients randomized to the control group will receive the regular RED intervention, including a follow-up phone call two days post-discharge from the hospital to review and confirm medications, and a referral to behavioral health. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All-cause readmission rates | The primary hypothesis is to test whether the RED intervention plus the collaborative-care approach for depression (RED-D) will reduce the all-cause 30 and 90 day hospital readmission rates for patients who screen positive for depressive symptoms | 30 days and 90 days post-discharge from hospital at index admission | 
| All-cause reutilization rates | The primary hypothesis is to test whether the RED intervention plus the collaborative-care approach for depression (RED-D) will reduce the all-cause 30 and 90 day hospital utilization rates for patients who screen positive for depressive symptoms | 30 & 90 days post discharge from index hospitalization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cost-saving | The economic analysis will investigate whether the two interventions are cost saving and whether the RED-D intervention is more cost saving than the RED intervention alone. The principal source of the savings is likely to be from reduced rehospitalizations within the 90 days of study follow-up. Hospital administrative records and insurance company data will be used to gather cost data. Additional costs of the two interventions will be estimated by costing staff time and other resources used. Cost-savings will be estimated by t-test comparisons of the mean costs for the groups; given randomization of patient assignment these will provide unbiased estimates. | 90 & 180 after discharge from index hospitalization | 
| Mental Health Related Quality of Life | The impact of the RED-D Collaborative Care Intervention mental health related quality of life will be ascertained using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and Work and Social Adjustment Scale (WSAS) . The investigators will test whether collaborative care for depression can produce a clinically meaningful improvement in mental health related quality of life compared to those patients receiving either usual care or the RED discharge alone. | 30 days and 90 days after discharge from index admission | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehospitalization, Reutilization, Depressive Symptoms, Pharmacotherapy, Cognitive Therapy, Self-help, Complementary Therapies