Clinical trial NCT02752321: An Electronic Multimedia Discharge Application
Official title: Video Assisted Transitions of Care: The Power of Video for Hospital Discharge Process
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Hospital Inpatients
Keywords: patient discharge
patient engagement
patient satisfaction
continuity of patient care
hospital discharge
health technology
eDischarge
multimedia
mobile applications
software applications
portable electronic applications
Lead sponsor: Northwell Health
Sponsor class: OTHER
First posted: 2016-04-26
Enrollment: 117
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: The purpose of this study is to determine whether the addition of a mobile or web based multimedia discharge application (eDischarge) to the discharge process is effective in improving patient experience, engagement, and clinical outcomes in the early post discharge period.

Detailed description: Hospital discharge is an essential transition of a patient's care from the inpatient health care team to the patient and caregiver. While a variety of factors may contribute to the effective discharge process, adequate communication between all parties significantly contributes to better outcomes. However, studies indicate that nearly one in five Medicare patients are re-hospitalized within one month of discharge due to lack of patient understanding and compliance to the post-hospital plan of care.

The standard discharge process, which is similar across all disease etiologies, has not changed significantly in many years and lags behind today's technological advances. Currently, the standard discharge process most commonly is delivered as a written document. This document summarizes the patient's hospitalization and discharge instructions in a plain text format, not significantly personalized, and is reviewed with the patient and caregivers usually at time of the discharge. Patients may not pay attention or understand the clinical information communicated to them and may not remember the dialogues during the discharge. In addition, patients often misplace their discharge papers and will not follow the post discharge instructions.

In early 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was adopted to promote the meaningful use of health information technology. Stage 1 of HITECH centered on 5 underlying health outcomes of meaningful use: (1) improve quality, safety, efficiency, and reduce health disparities; (2) engage patients and families in their healthcare; (3) improve care coordination; (4) improve population and public health; and (5) ensure adequate privacy and security protections for personal health information. While the passage of HITECH and application of new database technologies has prompted an increase in the use of electronic health records (EHR), the incentives of meaningful use has not been widely applied (Hsiao and Hing)3.

The current "Age of the Internet" and its ability to deliver data to almost any physical locale instantaneously, including high resolution audio and video, has fostered new ways to create, view and share information - including, potentially, medical records. eDischarge is a new multimedia technology designed to supplement the discharge process and enhance provider-patient communication by facilitating the delivery of discharge and follow-up information to patients. Designed as a secure, HIPPA-compliant, cloud-based software platform, participants are able to access the eDischarge system using a personal computer or a mobile device, which can enhance access to health information for the patient. Through eDischarge, participants are given personalized videos, documents, and images tailored specifically to their particular medical care. eDischarge permits inclusion of both structured health information exchange data as well as medical data to be added to discharge. Providers are able to asynchronously create content throughout a participant's hospital stay, which the participant will be able to access post discharge. The investigators believe that this technology has the potential to improve patient engagement and experience as well as enhance a patient's understanding of his disease process and treatment.

Eligibility criteria: Inclusion Criteria:

* Male and female patients ages 18 years and above
* Access to mobile device (phone/tablet) and/or computer at home
* Admission to Lenox Hill Hospital under the Department of Neurosurgery
* Discharge to home and rehab facilities where patients can be accessed

Exclusion Criteria:

* Irreversible impaired brain stem function (bilateral fixed, dilated pupils and extensor motor posturing)
* Patients not expected to survive to the 30 day visit due to co-morbidities or are Do No Resuscitate/Do Not Intubate (DNR/DNI) status prior to randomization
* Patients transferred to a different hospital service or a nursing home
* Patients on hospital precautions or suicide watch, or are deaf or blind
* Any concurrent serious illness that would interfere with the outcome assessments including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, immunologic, and hematologic disease.
* Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational technology were initiated.

Primary outcomes:
measure: Post Discharge Survey
timeFrame: 7-14 Days Post-Discharge
measure: Post Discharge Survey
timeFrame: 7-14 Days Post-Discharge
Secondary outcomes:
measure: Patient Discharge Experience (eDischarge Questionnaire)
timeFrame: 7-14 Days Post-Discharge
measure: Patient Discharge Experience (Standard Discharge Questionnaire)
timeFrame: 7-14 Days Post-Discharge
measure: Hospital Readmission Rate
timeFrame: 30-45 Days Post Discharge
measure: ED Visit Rate
timeFrame: 30-45 Days Post Discharge
Other outcomes:
Locations:
city: New York
country: United States
facility: Lenox Hill Hospital
state: New York
Study officials:
affiliation: Northwell Health
name: David J. Langer, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003 Feb 4;138(3):161-7. doi: 10.7326/0003-4819-138-3-200302040-00007.
citation: Lai M, Kheterpal S. Creating a real return-on-investment for information system implementation: life after HITECH. Anesthesiol Clin. 2011 Sep;29(3):413-38. doi: 10.1016/j.anclin.2011.05.005.
citation: Hsiao CJ, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2013. NCHS Data Brief. 2014 Jan;(143):1-8.
citation: Berkman ND, Dewalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and health outcomes. Evid Rep Technol Assess (Summ). 2004 Jan;(87):1-8. No abstract available.