Clinical trial NCT01840826: Reducing Hospital Readmissions in Patients With Depressive Symptoms
Official title: Reducing Hospital Readmission Among Medical Patients With Depressive Symptoms
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Depression
Keywords: Rehospitalization
Reutilization
Depressive Symptoms
Pharmacotherapy
Cognitive Therapy
Self-help
Complementary Therapies
Lead sponsor: Boston Medical Center
Sponsor class: OTHER
Collaborators: name: Agency for Healthcare Research and Quality (AHRQ)
First posted: 2013-04-26
Enrollment: 709
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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.


Eligibility criteria: 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

Primary outcomes:
measure: All-cause readmission rates
timeFrame: 30 days and 90 days post-discharge from hospital at index admission
measure: All-cause reutilization rates
timeFrame: 30 & 90 days post discharge from index hospitalization
Secondary outcomes:
measure: cost-saving
timeFrame: 90 & 180 after discharge from index hospitalization
measure: Mental Health Related Quality of Life
timeFrame: 30 days and 90 days after discharge from index admission
Other outcomes:
Locations:
city: Boston
country: United States
facility: Boston Medical Center
state: Massachusetts
Study officials:
affiliation: Boston University
name: Brian W Jack, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Mitchell SE, Paasche-Orlow MK, Forsythe SR, Chetty VK, O'Donnell JK, Greenwald JL, Culpepper L, Jack BW. Post-discharge hospital utilization among adult medical inpatients with depressive symptoms. J Hosp Med. 2010 Sep;5(7):378-84. doi: 10.1002/jhm.673.
citation: Jack B, Greenwald J, Forsythe S, O'Donnell J, Johnson A, Schipelliti L, Goodwin M, Burniske GM, Hesko C, Paasche-Orlow M, Manasseh C, Anthony D, Martin S, Hollister L, Jack M, Jhaveri V, Casey K, Chetty VK. Developing the Tools to Administer a Comprehensive Hospital Discharge Program: The ReEngineered Discharge (RED) Program. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug. Available from http://www.ncbi.nlm.nih.gov/books/NBK43688/
citation: Anthony D, Chetty VK, Kartha A, McKenna K, DePaoli MR, Jack B. Re-engineering the Hospital Discharge: An Example of a Multifaceted Process Evaluation. In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb. Available from http://www.ncbi.nlm.nih.gov/books/NBK20484/
citation: Clancy CM. Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction. Am J Med Qual. 2009 Jul-Aug;24(4):344-6. doi: 10.1177/1062860609338131. Epub 2009 Jun 5. No abstract available.
citation: Mitchell SE, Reichert M, Howard JM, Krizman K, Bragg A, Huffaker M, Parker K, Cawley M, Roberts HW, Sung Y, Brown J, Culpepper L, Cabral HJ, Jack BW. Reducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial. Ann Fam Med. 2022 May-Jun;20(3):246-254. doi: 10.1370/afm.2801.