Randomised controlled pragmatic clinical trial evaluating the effectiveness of a discharge follow-up phone call on 30-day hospital readmissions: balancing pragmatic and explanatory design considerations
| Autor: | Cheryl L Gatto, Daniel W. Byrne, Michele Hasselblad, Li Wang, Monisha C Bhatia, Frank E. Harrell, Maame Yaa A. B. Yiadom, Tina V. Hartert, Sunil Kripalani, Johnston Morrison, Sarah Tucker, Gordon R. Bernard, Neesha N. Choma, Henry J. Domenico |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male media_common.quotation_subject Psychological intervention Aftercare Patient Readmission 01 natural sciences 03 medical and health sciences 0302 clinical medicine Patient satisfaction transition of care Ambulatory care hospital readmission Health care Protocol Clinical endpoint Humans Medicine Quality (business) 030212 general & internal medicine Mortality 0101 mathematics pragmatic clinical trial media_common business.industry Communication 010102 general mathematics Transitional Care General Medicine Emergency department medicine.disease Patient Discharge Telemedicine Telephone 3. Good health Hospitalization Clinical trial discharge phone call Evidence Based Practice Patient Satisfaction Research Design Female Medical emergency Emergency Service Hospital business |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2017-019600 |
| Popis: | IntroductionHospital readmissions within 30 days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients’ successful transition from inpatient to outpatient care is a continued challenge.Methods and analysisThis is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions. Our primary endpoint is inpatient readmission within 30 days of hospital discharge censored for death analysed with an intention-to-treat approach. Secondary endpoints included observation status readmission within 30 days, time to readmission, all-cause emergency department revisits within 30 days, patient satisfaction (measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems scores) and 30-day mortality. Exploratory endpoints include the need for assistance with discharge plan implementation among those randomised to the intervention arm and reached by the study nurse, and the number of call attempts to achieve successful intervention delivery. Consistent with the Learning Healthcare System model for clinical research, timeliness is a critical quality for studies to most effectively inform hospital clinical practice. We are challenged to apply pragmatic design elements in order to maintain a high-quality practicable study providing timely results. This type of prospective pragmatic trial empowers the advancement of hospital-wide evidence-based practice directly affecting patients.Ethics and disseminationStudy results will inform the structure, objective and function of future iterations of the hospital’s discharge follow-up phone call programme and be submitted for publication in the literature.Trial registration numberNCT03050918; Pre-results. |
| Databáze: | OpenAIRE |
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