Clinical trial NCT03970174: Care Transition Patient Experience Study With Electronic Tool
Official title: Evaluating the Impact of an Electronic Communication Tool on Patient Experience, ED Visits and Re-hospitalization, and Care Transitions in Hospitalized Patients (Including Those With Dementia): a Mixed Methods Study
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Care Transition
Communication
Keywords: Patient experience
Lead sponsor: Trillium Health Partners
Sponsor class: OTHER
Collaborators: name: Centre for Aging and Brain Health Innovation
First posted: 2019-05-31
Enrollment: 240
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Care Connector care transition module will be rolled out at 2 of 4 wards (intervention) while the other 2 wards will have usual care
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Patients being admitted to hospital are becoming more complex and they often require a team of health professionals (doctors from different disciplines, nurses, and allied health professionals) working together to meet their needs. Effective communication among this team and with patients is essential to providing high quality patient-centered care. Care Connector is an electronic tool that was developed to help health professionals communicate about patient care with each other. It also incorporates best practice whenever possible (such as the used of Patient Oriented Discharge Summary \[PODS\] developed at University Health Network) during care transitions. We want to understand whether using electronic tools can address the communication issues faced by patients/families, and whether they impact on repeat visits to the Emergency Department or the hospital after discharge. In this study, we will be asking patients and families who have recently been discharged from hospital to describe their experience with communication and care transitions through a brief telephone survey. All of them will be discharged from units where Care Connector was used. However, some of the units would have used the PODS feature while others will not. A small group will also be invited to participate in an in-depth telephone interview. The results of this study will be used to improve Care Connector and to enhance communication and patient experience in general.

Detailed description: In this mixed methods study, we examine how electronic tools impact patient/family experience of communication in hospital and care transitions from hospital to home. Care Connector is an electronic interprofessional communication and collaboration platform initially designed to address communication challenges faced by interprofessional care team. It has been augmented to support care transitions through a care transition module (that include the generation of provider-facing discharge summary and PODS). This study examines the impact of this care transition module on patient/family experience of in-hospital communication and care transitions. The quantitative component is a controlled study where baseline data is collected on 4 medicine wards. The care transition module is then introduced to 2 of the 4 medicine wards (intervention) while the other 2 (control) wards continue to operate without the explicit use of the care transition module. Data is then collected again on all 4 wards to understand impact of patient/family experience, as well as objective outcomes of ED visits and re-admission within 30 days. A number of care transition process measures will also be obtained. In the qualitative component, we will interview patients/families, as well as healthcare providers to understand how technology can or cannot address these issues.

Eligibility criteria: Inclusion Criteria:

1. General medical patients cared for and discharged by the Hospitalist service
2. Be 18 years of age and above
3. Length of stay for hospitalization is at least 48 hours
4. The discharge destination is home (with or without support), or retirement home
5. Has the cognitive ability to, or has a substitute decision maker (SDM) (if patient is not capable) able to, provide informed consent for this research study
6. Can be contacted by telephone up to 30 days post discharge
7. Able to respond to survey questions over telephone (assistance from family member or other caregiver at the time of telephone survey is permitted)

Exclusion Criteria:

1. Discharged from a non-Medicine ward (e.g. medicine patient bed spaced to a surgical ward) or from the Emergency Department directly
2. Previously participated in this study (in case of re-admission)
3. Discharge destination is another acute care facility, rehab, palliative care unit, complex continuing care, long term care, or any other facility not listed in inclusion criteria 4.
4. Died in hospital
5. Unable to give informed consent due to language barrier and lack of suitable assistance from family members and/or caregivers and/or SDM (if patient is not capable)
6. Cannot be contacted by telephone after discharge
7. Unable to respond to telephone survey questions for any reason (e.g. hearing impairment, language barrier) and lack of availability of family members and/or other caregivers willing and able to provide assistance

Primary outcomes:
measure: Care transition measure 3
timeFrame: Up to 30 days post discharge
Secondary outcomes:
measure: In-hospital communication
timeFrame: Up to 30 days post discharge
measure: ED visit
timeFrame: 30 days post discharge
measure: Hospitalization
timeFrame: 30 days post discharge
measure: Presence of follow up plan in discharge summary
timeFrame: At the time of patient discharge (0 days)
measure: Proportion of appointments with date/time confirmed at discharge
timeFrame: At time of patient discharge (0 days)
measure: Proportion of patients referred to community support services
timeFrame: At time of patient discharge (0 days)
Other outcomes:
measure: Subgroup analysis of patients with dementia
timeFrame: Up to 30 days post patient discharge
Locations:
city: Mississauga
country: Canada
facility: Trillium Health Partners
state: Ontario
Study officials:
affiliation: Trillium Health Partners
name: Terence Tang, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Hahn-Goldberg S, Okrainec K, Huynh T, Zahr N, Abrams H. Co-creating patient-oriented discharge instructions with patients, caregivers, and healthcare providers. J Hosp Med. 2015 Dec;10(12):804-7. doi: 10.1002/jhm.2444. Epub 2015 Sep 25.
citation: Parry C, Mahoney E, Chalmers SA, Coleman EA. Assessing the quality of transitional care: further applications of the care transitions measure. Med Care. 2008 Mar;46(3):317-22. doi: 10.1097/MLR.0b013e3181589bdc.
citation: Tang T, Lim ME, Mansfield E, McLachlan A, Quan SD. Clinician user involvement in the real world: Designing an electronic tool to improve interprofessional communication and collaboration in a hospital setting. Int J Med Inform. 2018 Feb;110:90-97. doi: 10.1016/j.ijmedinf.2017.11.011. Epub 2017 Nov 22.