Trial of Emergency Department Discharge With Enhanced Transitions of Care Compared to Usual Care

Study Overview
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Brief Summary
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This is a randomized controlled trial to assess the relative effectiveness of providing Enhanced Transitions of Care (ETOC) to improve patient outcomes after discharge from the Emergency Department (ED). Patients who are being discharged from the ED and have had a previous ED visit or hospital admission within the Thomas Jefferson Hospital System (TJUH or Methodist) within the past 90 days will be eligible for enrollment in this trial. Patients who consent to enrollment will be randomized to discharge by usual care or discharge with ETOC as provided by the company BoardRounds.

Official Title
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Randomized Control Trial of Emergency Department Discharge With Enhanced Transitions of Care Compared to Usual Care

Conditions
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Patient Discharge, Emergency Care

Intervention / Treatment
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* Other: ETOC


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult (18 yrs and older) patients Have had a previous ED visit or hospital admission in the 90 days prior to the current ED visit (at Thomas Jefferson University Hospital or Methodist Hospital) Have just completed evaluation in the Thomas Jefferson University Hospital Emergency Department for any problem, Are ready for discharge from the Thomas Jefferson University Hospital ED, and Provide informed consent Exclusion Criteria: Non-English speaking patients Patients undergoing medical clearance for a detox center or any involuntary court or magistrate order Patients who live outside Philadelphia area (unable to seek follow-up care in Philadelphia) or other condition known to preclude follow-up (such as no reliable access to a telephone) Patients in police custody or currently incarcerated individuals Patients who have, in their clinician's best judgment, major communication barriers such as visual or hearing impairment or dementia that would compromise their ability to give written 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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Discharge from emergency department by usual care | |
| Experimental: ETOC<br>Discharge from emergency department with increased support services provided by BoardRounds after ED discharge | Other: ETOC<br>* Services provided to assist patients in accessing needed healthcare services after emergency department discharge such as scheduling appointments, finding new doctors, getting medications, or addressing problems with insurance coverage.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total number of ED visits, hospital admissions, and outpatient office visits as determined by medical record review and patient report | 30-day healthcare utilization will be measured by assessing the total number of ED treat-and-release visits, hospital admissions, and outpatient care visits in the 30 days after study enrollment - will be reported in aggregate and separately for each type of utilization (ED, inpatient hospital stay, office visit). Counts will be determined by medical record review for visits occurring within the health system, and will be supplemented by patient report in a 30-day survey to determine utilization outside the health system. | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total number of ED visits, hospital admissions, and outpatient office visits as determined by medical record review and patient report | 9-day healthcare utilization will be measured by assessing the total number of ED treat-and-release visits, hospital admissions, and outpatient care visits in the 30 days after study enrollment - will be reported in aggregate and separately for each type of utilization (ED, inpatient hospital stay, office visit). Counts will be determined by medical record review for visits occurring within the health system, and will be supplemented by patient report in a 30-day survey to determine utilization outside the health system. | 9 days | 
| Description of types of and count (per type) of assistance received by patients in accessing needed healthcare services as assessed by patient survey | Patients will be surveyed at 30 days to determine the types of assistance received, and frequency with which each type was received, in accessing needed healthcare services since their discharge from the ED. | 30 days | 
| Description of types of and count (per type) of assistance received by patients in accessing needed healthcare services as assessed by patient survey | Patients will be surveyed at 30 days to determine the types of assistance received, and frequency with which each type was received, in accessing needed healthcare services since their discharge from the ED. | 9 days | 
| Assessment of whether patient had unmet needs in accessing needed healthcare services, as determined by patient survey | Determination of whether patient had unmet needs (yes/no) in accessing needed healthcare services in the 30-days after ED discharge as identified by patient in a survey administered at 30 days post-discharge. | 30 days | 
| Assessment of whether patient had unmet needs in accessing needed healthcare services, as determined by patient survey | Determination of whether patient had unmet needs (yes/no) in accessing needed healthcare services in the 9-days after ED discharge as identified by patient in a survey administered at 9 days post-discharge. | 9 days |