Post-Acute Physician Home Visit Program

Study Overview
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Brief Summary
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New or worsening symptoms following discharge from the hospital likely leads to unplanned readmission. These rates are higher than desired and costly to patients, payers, and providers. Many interventions have unsuccessfully attempted to reduce readmissions, but few have provided in-home personnel to patients transitioning from acute care back to ambulatory care. Still fewer have involved a physician in the home. We therefore will test the effect of a physician home visit to a patient's home who was discharged in the last 4 days.

Official Title
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Post-Acute Physician Home Visits: A Randomized Controlled Trial

Conditions
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A Patient Discharged From an Acute-care Hospital Who Had an Acute Illness

Intervention / Treatment
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* Other: Home visit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Resides within either a 5-mile or 20-minute driving radius of Brigham and Women's Hospital (BWH) or Brigham and Women's Faulkner Hospital (BWFH) emergency room Has capacity to consent to study >=18 years old Exclusion Criteria: Undomiciled In police custody Domestic violence screen positive

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 |
| --- | --- |
| Experimental: Home visit<br>A participant in this arm will receive a home visit after discharge from the hospital. | Other: Home visit<br>* The visit will be entirely patient tailored, last approximately one hour, and at a minimum will entail: Medical assessment Psychosocial assessment Medication reconciliation Follow-up of inpatient primary team's specific recommendations Follow-up, as needed, with primary care team or inpatient team<br>|
| No Intervention: Usual Care<br>A participant in this arm will not receive a home visit after discharge from the hospital. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| New or worsening symptoms | Since you got home from the hospital, have you had any symptoms at all? If no, stop. If yes, continue. I'm going to read off a list of symptoms, and I want you to tell me if that symptom is new or has gotten worse since you left the hospital. Please don't include symptoms that have stayed the same since you were in the hospital. For each affirmative, double check if the symptom is new or has gotten worse since getting out of the hospital. Only if new or worse, mark yes. | 30 days after discharge from hospital | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total cost, 30-days post discharge |  | Day of discharge to 30 days later | 
| Total reimbursement, 30-days post discharge |  | Day of discharge to 30 days later | 
| 3-item Care Transition Measure, score |  | 30 days after discharge | 
| Primary care provider follow-up within 14 days, y/n |  | Day of discharge to 14 days later | 
| Ability to carry out the discharge plan, score | I would like to ask you about some more problems that you might have faced after you left the hospital one month ago. I will read some statements and ask if you agree or disagree. | 30 days after discharge | 
| Change in medication list due to home visit, y/n | Physician-initiated medication change during home visit | Day of home visit | 
| Receipt of prescribed medicines following discharge, y/n | Pharmacy confirmation | 30 days after discharge | 
| Unplanned 30-day readmission(s) after index hospitalization, y/n |  | 30 days after discharge | 
| Unplanned 30-day readmission(s) after index hospitalization, # |  | 30 days after discharge |