Clinical trial NCT04639102: Practical Alternative to Hospitalization
Official title: Practical Alternative to Hospitalization
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Emergency Department
Health, Subjective
Health Care Utilization
Lead sponsor: University of Pennsylvania
Sponsor class: OTHER
Collaborators: name: Independence Blue Cross
First posted: 2020-11-20
Enrollment: 72
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: The investigators test the PATH program to evaluate whether the program allows patients to spend more days at home in comparison to patients who receive regular care. The program will involve patients from Penn Presbyterian Medical Center with a set of diagnoses and will provide patients with enhanced services upon discharge from the emergency department.

Detailed description: The PATH program seeks to provide patients with enhanced services upon discharge from the emergency department, including visiting home nurses, visiting home physical and occupational therapists, scheduled frequent telephone visits with a medical provider, care coordination to arrange outpatient evaluation and testing, social work services, and other services. The purpose of this study is to evaluate whether the PATH program allows patients to spend more days at home in comparison to patients who receive regular care.

The broad goal of this program is to provide patients with a personalized package of enhanced services following discharge from the emergency department. In some cases, patients enrolled in the PATH program are likely to be discharged home regardless of enrollment, but are deemed potentially high-risk for returning to the hospital due to their illness or other factors. In other cases, enrolled patients might otherwise have been hospitalized but decide with their clinician that recovery at home is possible with the increased supervision and care provided by PATH. For all patients, we seek to determine whether PATH is effective in expediting patient recovery from acute illness and reduce the time spent in hospital or nursing facilities.

Eligibility criteria: Inclusion Criteria:

* Stable (Patients are deemed stable by ED clinician and PATH clinician per review of vital signs, history, exam, test results, and functional status)
* Have active insurance
* Domiciled at home (Patients must live in the community and not in nursing facility, shelter, or otherwise homeless)
* Safe home environment
* Live in Penn Medicine Home Health (PMHH) geographic catchment if enrolled in PMHH services

Exclusion Criteria:

* Substance use disorder (No active untreated SUD, including alcohol, opioids, cocaine, or stimulants)
* Serious mental health condition
* Police custody
* Homelessness
* Anticipated procedures or surgeries
* IV access (Patients with need for home infusion services or frequent blood testing after discharge must have standard level of IV access)

Primary outcomes:
measure: Days at home over 30 days
timeFrame: 30 days
measure: Days that patients are expired
timeFrame: 30 days
Secondary outcomes:
measure: Impact of PATH on hospital operations - Capture rate
timeFrame: 5 months
measure: Quality of life at 30 days
timeFrame: 5 months
measure: Functional status at 30 days
timeFrame: 5 months
measure: Estimated cost (allowed charges) based on healthcare utilization
timeFrame: 5 months
measure: Impact of PATH on hospital operations - percentage of hospitalized patients
timeFrame: 5 months
Other outcomes:
Locations:
city: Philadelphia
country: United States
facility: University of Pennsylvania
state: Pennsylvania
Study officials:
affiliation: University of Pennsylvania
name: Austin Kilaru, MD, MSHP
role: PRINCIPAL_INVESTIGATOR
References: