Clinical trial NCT05413889: Validation and Implementation Design of an Epic Systems 30-day Unplanned Readmission Risk Model
Official title: Validation and Implementation Design of a Pragmatic Randomized Controlled Trial Leveraging Epic Systems 30-day Unplanned Readmission Risk Model
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Unplanned Hospital Readmissions
Patients at High Risk of Unplanned Readmission
Lead sponsor: Wake Forest University Health Sciences
Sponsor class: OTHER
First posted: 2022-06-10
Enrollment: 68
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: intervention group (IG) or control group (CG). The IG will consist of placing the Epic 30-day unplanned readmission risk score in the story board of providers. If a patient is identified as having a high risk of readmission defined as readmission risk \>20%, a link to transitional and supportive care services (TSC) will be appear in the story board. Providers will determine which TSC is best for the patient and may order whichever TSC or any is appropriate for the patient. The CG will have the same TSC orders available to them; however, they will not have the risk of readmission score present in their workflow, as such the embedded link to TSC will also not be present. Providers, in both IG and CG, will have the option to order one or multiple TSC at their discretion.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The objective is to assess the implementation of a computerized clinical decision support (cCDS) tool for identifying patients at high risk of unplanned readmission who could benefit from existing care programs aimed at reducing readmissions

Detailed description: Providers from either service, which includes attending physicians, residents, hospitalists, and advanced practice providers (APPs), will be randomly allocated to an intervention group (IG) or control group (CG). The IG will consist of placing the Epic 30-day unplanned readmission risk score in the story board of providers. If a patient is identified as having a high risk of readmission defined as readmission risk \>20%, a link to transitional and supportive care services (TSC) will be appear in the story board. Providers will determine which TSC is best for the patient and may order whichever TSC is appropriate for the patient. The study team will not recommend TSCs. The risk of readmission score will be present from the time of admission for those in the IG. The CG will have the same TSC orders available to them; however, they will not have the risk of readmission score present in their workflow, as such the embedded link to TSC will also not be present.

Eligibility criteria: Inclusion Criteria:

* Patients of Atrium Health Wake Forest Baptist Hospital (AHWFBH)
* 18 years or older
* meeting inpatient criteria
* admitted to hospitalist or general medicine teaching services
* Providers on the hospitalist or general medicine teaching services

Exclusion Criteria:

* Psychiatric diagnoses during index or subsequent admission
* left Against Medical Advice (AMA)
* planned readmission
* died during index admission
* Providers who opt out of the study

Primary outcomes:
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Intervention group
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Control group
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Control group - Faith Health
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Control group - High Risk Readmission Program (HRI)
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Control group - Care Plus
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Control group - Population Health Pharmacy
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Control group - Geriatrics Transitional Care
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Control group - Mobile Health Clinic
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Intervention group - Faith Health
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Intervention group- High Risk Readmission Program (HRI)
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Intervention group - Care Plus
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Intervention group - Population Health Pharmacy
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Intervention group - Geriatrics Transitional Care
timeFrame: Day 30
measure: Number of transitional and supportive care services (TSC) referrals by providers in the Intervention group - Mobile Health Clinic
timeFrame: Day 30
measure: Provider Satisfaction Score
timeFrame: Day 30
Secondary outcomes:
measure: 30 day Readmission Rate
timeFrame: Day 30
Other outcomes:
Locations:
city: Winston-Salem
country: United States
facility: Wake Forest University Health Sciences
state: North Carolina
Study officials:
affiliation: Wake Forest University Health Sciences
name: Donna Williams, MD
role: PRINCIPAL_INVESTIGATOR
References: