Care Transition Patient Experience Study With Electronic Tool

Study Overview
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Brief Summary
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Patients being admitted to hospital are becoming more complex and they often require a team of health professionals (doctors from different disciplines, nurses, and allied health professionals) working together to meet their needs. Effective communication among this team and with patients is essential to providing high quality patient-centered care. Care Connector is an electronic tool that was developed to help health professionals communicate about patient care with each other. It also incorporates best practice whenever possible (such as the used of Patient Oriented Discharge Summary [PODS] developed at University Health Network) during care transitions. We want to understand whether using electronic tools can address the communication issues faced by patients/families, and whether they impact on repeat visits to the Emergency Department or the hospital after discharge. In this study, we will be asking patients and families who have recently been discharged from hospital to describe their experience with communication and care transitions through a brief telephone survey. All of them will be discharged from units where Care Connector was used. However, some of the units would have used the PODS feature while others will not. A small group will also be invited to participate in an in-depth telephone interview. The results of this study will be used to improve Care Connector and to enhance communication and patient experience in general.

Detailed Description
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In this mixed methods study, we examine how electronic tools impact patient/family experience of communication in hospital and care transitions from hospital to home. Care Connector is an electronic interprofessional communication and collaboration platform initially designed to address communication challenges faced by interprofessional care team. It has been augmented to support care transitions through a care transition module (that include the generation of provider-facing discharge summary and PODS). This study examines the impact of this care transition module on patient/family experience of in-hospital communication and care transitions. The quantitative component is a controlled study where baseline data is collected on 4 medicine wards. The care transition module is then introduced to 2 of the 4 medicine wards (intervention) while the other 2 (control) wards continue to operate without the explicit use of the care transition module. Data is then collected again on all 4 wards to understand impact of patient/family experience, as well as objective outcomes of ED visits and re-admission within 30 days. A number of care transition process measures will also be obtained. In the qualitative component, we will interview patients/families, as well as healthcare providers to understand how technology can or cannot address these issues.

Official Title
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Evaluating the Impact of an Electronic Communication Tool on Patient Experience, ED Visits and Re-hospitalization, and Care Transitions in Hospitalized Patients (Including Those With Dementia): a Mixed Methods Study

Conditions
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Communication, Care Transition

Intervention / Treatment
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* Other: Care Connector care transition module


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: General medical patients cared for and discharged by the Hospitalist service Be 18 years of age and above Length of stay for hospitalization is at least 48 hours The discharge destination is home (with or without support), or retirement home Has the cognitive ability to, or has a substitute decision maker (SDM) (if patient is not capable) able to, provide informed consent for this research study Can be contacted by telephone up to 30 days post discharge Able to respond to survey questions over telephone (assistance from family member or other caregiver at the time of telephone survey is permitted) Exclusion Criteria: Discharged from a non-Medicine ward (e.g. medicine patient bed spaced to a surgical ward) or from the Emergency Department directly Previously participated in this study (in case of re-admission) Discharge destination is another acute care facility, rehab, palliative care unit, complex continuing care, long term care, or any other facility not listed in inclusion criteria 4. Died in hospital Unable to give informed consent due to language barrier and lack of suitable assistance from family members and/or caregivers and/or SDM (if patient is not capable) Cannot be contacted by telephone after discharge Unable to respond to telephone survey questions for any reason (e.g. hearing impairment, language barrier) and lack of availability of family members and/or other caregivers willing and able to provide assistance

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: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Care Connector care transition module will be rolled out at 2 of 4 wards (intervention) while the other 2 wards will have usual care
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Two of the 4 Medicine wards will have implemented the care transition module of Care Connector | Other: Care Connector care transition module<br>* Care Connector is an electronic interprofessional communication and collaboration tool. Its features include Physician Sign-Out, documentation, interprofessional care planner, messaging, and flow planner. The newest module is a care transition module which allows physicians to electronically generate discharge summaries as well as incorporation of allied health recommendation, but also will pull information into the PODS (Patient Oriented Discharge Summary) format designed by University Health Network. This results in a patient friendly discharge instruction sheet that can be provided to patient. The intervention arm will have access to the care transition feature, while the control wards do not.<br>|
| No Intervention: Control<br>Remaining 2 of 4 Medicine wards will use all other aspects of Care Connector (except for care transition module) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Care transition measure 3 | This is a validated measure developed by Coleman et al (Med Care. 2008 Mar;46(3):317-22) to measure quality of care transitions. It contains 3 questions (please see reference for questions). | Up to 30 days post discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In-hospital communication | Subset of questions from the Canadian Patient Experience Survey - Inpatient Care (CPES-IC) | Up to 30 days post discharge | 
| ED visit | ED visit to any site at Trillium Health Partners | 30 days post discharge | 
| Hospitalization | Hospitalization to any site at Trillium Health Partners | 30 days post discharge | 
| Presence of follow up plan in discharge summary | Binary (yes/no) assessment of whether the dictated discharge summary contains a follow-up plan section. | At the time of patient discharge (0 days) | 
| Proportion of appointments with date/time confirmed at discharge | Number of appoints with date/time confirmed / total number of appointments | At time of patient discharge (0 days) | 
| Proportion of patients referred to community support services | Number of patients referred to community support services / total number of patients | At time of patient discharge (0 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Patient experience