Clinical trial NCT01108172: A Virtual Ward to Reduce Readmissions After Hospital Discharge
Official title: A Virtual Ward to Reduce Readmissions After Hospital Discharge
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Acute Disease
Lead sponsor: Unity Health Toronto
Sponsor class: OTHER
Collaborators: name: Canadian Institutes of Health Research (CIHR)
name: Toronto Central Local Health Integration Network
name: Ontario Ministry of Health and Long Term Care
name: Toronto Central Community Care Access Centre
name: Women's College Hospital
name: University Health Network, Toronto
name: Sunnybrook Health Sciences Centre
First posted: 2010-04-21
Enrollment: 1928
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: The purpose of this study is to see whether a Virtual Ward reduces readmissions after hospital discharge.

Detailed description: We will conduct a pragmatic, randomized controlled trial to evaluate a new model of care for high-risk medical patients after discharge from hospital. This new model of care has two key elements. First, we will use the LACE index (see citation below for details) to identify patients who are at high risk of readmission or death after hospital discharge. These patients will be randomized to either the Virtual Ward or usual care on the day of discharge. Although patients being cared for in the Virtual Ward will reside at home, they will benefit from a hospital-like interdisciplinary team, a shared set of notes, a single point of contact, round-the-clock physician availability and increased co-ordination of specialist, primary and home-based community care for several weeks after hospital discharge.

Eligibility criteria: Inclusion Criteria:

* Discharge from medical service
* LACE score greater than or equal to 10
* Age greater than or equal or 18
* Resident in Toronto Central Local Health Integration Network catchment area
* Patient or designate able to speak English well enough for follow up telephone calls

Exclusion Criteria:

* Previously enrolled in study
* Discharged to a rehabilitation or complex continuing care facility

Primary outcomes:
measure: Composite of readmission to hospital or death.
timeFrame: 30 days after hospital discharge
Secondary outcomes:
measure: Composite of readmission or death
timeFrame: 90 days after discharge
measure: Composite of readmission or death
timeFrame: 6 months after discharge
measure: Composite of readmission or death
timeFrame: One year after discharge
measure: Emergency department visits
timeFrame: 30 days after discharge
measure: Emergency department visits
timeFrame: 90 days after discharge
measure: Emergency department visits
timeFrame: 6 months after discharge
measure: Emergency department visits
timeFrame: One year after discharge
measure: Long-term care admission
timeFrame: 30 days after discharge
measure: Long-term care admission
timeFrame: 90 days after discharge
measure: Long-term care admission
timeFrame: 6 months after discahrge
measure: Long-term care admission
timeFrame: One year after discharge
measure: Death
timeFrame: 90 days after discharge
measure: Death
timeFrame: 6 months after discharge
measure: Death
timeFrame: One year after discharge
measure: Death
timeFrame: 30 days after discharge
measure: Composite of readmission to hospital or death.
timeFrame: One year after discharge
measure: Readmission
timeFrame: One year after discharge
measure: Emergency department visits
timeFrame: One year after discharge
measure: Long-term care admission
timeFrame: One year after discharge
measure: Death
timeFrame: One year after discharge
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: St. Michael's Hospital
state: Ontario
city: Toronto
country: Canada
facility: Sunnybrook Health Sciences Centre
state: Ontario
city: Toronto
country: Canada
facility: Toronto Central Community Care Access Centre
state: Ontario
city: Toronto
country: Canada
facility: University Health Network
state: Ontario
city: Toronto
country: Canada
facility: Women's College Hospital
state: Ontario
Study officials:
affiliation: St. Michael's Hospital/University of Toronto
name: Irfan Dhalla, MD, MSc
role: PRINCIPAL_INVESTIGATOR
References:
citation: van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, Austin PC, Forster AJ. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010 Apr 6;182(6):551-7. doi: 10.1503/cmaj.091117. Epub 2010 Mar 1.
citation: Dhalla IA, O'Brien T, Morra D, Thorpe KE, Wong BM, Mehta R, Frost DW, Abrams H, Ko F, Van Rooyen P, Bell CM, Gruneir A, Lewis GH, Daub S, Anderson GM, Hawker GA, Rochon PA, Laupacis A. Effect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial. JAMA. 2014 Oct 1;312(13):1305-12. doi: 10.1001/jama.2014.11492.