Effects Of Income Supplements On 30-Day Readmissions For Vulnerable Older Adults

Study Overview
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Brief Summary
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Unplanned 30-day hospital readmissions are an critical healthcare quality metric, with meaningful effects on patients and health systems operations. Interventions to reduce unplanned readmissions have primarily operated within a healthcare-centric frame, with enhancements to either pre- or post-discharge care planning, medication reconciliation, or visit frequency. Associations of 30-day readmission rates with poverty status and other social factors, however, suggest that attending to unmet social needs may yield added benefits to models focused on healthcare delivery. The purpose of the present trial is to provide evidence regarding the effects on 30-day readmissions of providing a one-time post-discharge income supplement to socially vulnerable older adults with medical complexity participating in an enhanced care coordination program.

Official Title
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Effects Of Income Supplements On 30-Day Readmissions For Vulnerable Older Adults: A Randomized, Controlled, 300-Subject Clinical Trial

Conditions
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Patient Readmission

Intervention / Treatment
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* Other: Post-discharge income supplement
* Other: Enhanced care planning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: A participant in the underlying enhanced care planning program aged 55 years or older attending an outpatient clinic appointment as part of the underlying enhanced care planning program within 10 days of being discharged from an inpatient hospital stay able to understand the study consent form (with interpretation services if needed) Exclusion Criteria: The candidate is not discharged from the index admission to a community setting (e.g., they will be excluded if they are discharged to a skilled nursing facility) The candidate has a legal guardian with control over financial decision-making The candidate has been approached about the study during a previous encounter The index hospitalization was a planned admission

Ages Eligible for Study
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Minimum Age: 55 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control<br>Enhanced care planning only (plus $15 as compensation for participation) | Other: Enhanced care planning<br>* Enhanced care planning provided by a nurse care manager<br>|
| Experimental: Intervention<br>Enhanced care planning plus a one-time $300 post-discharge income supplement | Other: Post-discharge income supplement<br>* $300 income supplement<br>Other: Enhanced care planning<br>* Enhanced care planning provided by a nurse care manager<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unplanned 30-day readmission | Whether a participant has an unplanned readmission within 30 days of the index hospital discharge | Within 30 days of the index hospital discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 30-day post-discharge medical expenditures | Total medical expenditures in the 30 days after the index hospital discharge | Within 30 days of the index hospital discharge | 
| 90-day post-discharge medical expenditures | Total medical expenditures in the 90 days after the index hospital discharge | Within 90 days of the index hospital discharge | 
| 30-day post-discharge medical readmission OR emergency department visit | Whether a participant has an unplanned readmission OR emergency department visit within 30 days of the index hospital discharge | Within 30 days of the index hospital discharge | 
| 90-day post-discharge medical readmission OR emergency department visit | Whether a participant has an unplanned readmission OR emergency department visit within 90 days of the index hospital discharge | Within 90 days of the index hospital discharge | 
| Unplanned 90-day readmission | Whether a participant has an unplanned readmission within 90 days of the index hospital discharge | Within 90 days of the index hospital discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Income, Patient Readmission