Care TransitionNCT03970174
Care Transition Patient Experience Study With Electronic Tool
A study testing Care Connector care transition module in people with Care Transition and Communication, run by Trillium Health Partners at 1 site in Canada.
Trial 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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Care Transition, Communication
- What is being tested?
- Care Connector care transition module
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 240 participants
- Where
- 1 siteCanada
- Study dates
- 2 Feb 2018to 30 Jun 2020
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- General medical patients cared for and discharged by the Hospitalist service
- Be 18 years of age and above
- Length of stay for hospitalization is at least 48 hours
- The discharge destination is home (with or without support), or retirement home
- 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
- Can be contacted by telephone up to 30 days post discharge
- Able to respond to survey questions over telephone (assistance from family member or other caregiver at the time of telephone survey is permitted)
Who cannot join
- Discharged from a non-Medicine ward (e.g. medicine patient bed spaced to a surgical ward) or from the Emergency Department directly
- Previously participated in this study (in case of re-admission)
- 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.
- Died in hospital
- 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)
- Cannot be contacted by telephone after discharge
- 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
Trial locations and contacts
1 site in 1 country.
About this study
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
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.
Read the 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.
- Conditions
- Care Transition, Communication
- Being tested
- Care Connector care transition module
- Keywords
- Patient experience
- Medical subject headings
- Communication
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Care Connector care transition moduleOther
Care Connector is an electronic interprofessional communication and collaboration tool. Its features include Physician Sign-Out, documentation, interprofessional care planner, messaging, and flow planner. The newest module is a care transition module which allows physicians to electronically generate discharge summaries as well as incorporation of allied health recommendation, but also will pull information into the PODS (Patient Oriented Discharge Summary) format designed by University Health Network. This results in a patient friendly discharge instruction sheet that can be provided to patient. The intervention arm will have access to the care transition feature, while the control wards do not.
| Study group | Role | What they receive |
|---|---|---|
| Intervention | Experimental | Two of the 4 Medicine wards will have implemented the care transition module of Care Connector Receives: Other: Care Connector care transition module |
| Control | No intervention | Remaining 2 of 4 Medicine wards will use all other aspects of Care Connector (except for care transition module) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Care transition measure 3
This is a validated measure developed by Coleman et al (Med Care. 2008 Mar;46(3):317-22) to measure quality of care transitions. It contains 3 questions (please see reference for questions).
Measured: Up to 30 days post discharge
Secondary outcomes (6)
In-hospital communication
Subset of questions from the Canadian Patient Experience Survey - Inpatient Care (CPES-IC)
Measured: Up to 30 days post discharge
ED visit
ED visit to any site at Trillium Health Partners
Measured: 30 days post discharge
Hospitalization
Hospitalization to any site at Trillium Health Partners
Measured: 30 days post discharge
Presence of follow up plan in discharge summary
Binary (yes/no) assessment of whether the dictated discharge summary contains a follow-up plan section.
Measured: At the time of patient discharge (0 days)
Proportion of appointments with date/time confirmed at discharge
Number of appoints with date/time confirmed / total number of appointments
Measured: At time of patient discharge (0 days)
Proportion of patients referred to community support services
Number of patients referred to community support services / total number of patients
Measured: At time of patient discharge (0 days)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 May 2019
- Study start2 Feb 2018
- Primary completion31 Jul 2019
- Study completion30 Jun 2020 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Care TransitionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- 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
- Masking
- None (open label)
- Enrolment
- 240 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Trillium Health Partners
- Sponsor type
- University, hospital or other
- Collaborators
- Centre for Aging and Brain Health Innovation
- Responsible party
- Sponsor
- Investigators
- Terence Tang, MD, Principal investigator, Trillium Health Partners
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03970174
- Sponsor's protocol ID
- 828
- Status last verified
- Mar 2020
- First submitted
- 9 May 2019
- Last updated
- 11 Mar 2020
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
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.
PubMed 26406116Parry 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.
PubMed 18388847Tang 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.
PubMed 29331258
Study at a glance
From the registry record, last updated by the sponsor on 11 Mar 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- 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
- ClinicalTrials.gov ID
- NCT03970174
- Acronym / sponsor ID
- 828
- Conditions
- Care Transition, Communication
- Keywords
- Patient experience
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 240 participants (estimated)
- Lead sponsor
- Trillium Health PartnersUniversity, hospital or other
- Collaborators
- Centre for Aging and Brain Health Innovation
- Study start
- 2 Feb 2018 (actual)
- Primary completion
- 31 Jul 2019 (actual)
- Study completion
- 30 Jun 2020 (estimated)
- First posted
- 31 May 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Health services research
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- 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
| Arm | Type | Receives |
|---|---|---|
| Intervention | Experimental | Other: Care Connector care transition moduleTwo of the 4 Medicine wards will have implemented the care transition module of Care Connector |
| Control | No intervention | –Remaining 2 of 4 Medicine wards will use all other aspects of Care Connector (except for care transition module) |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- General medical patients cared for and discharged by the Hospitalist service
- Be 18 years of age and above
- Length of stay for hospitalization is at least 48 hours
- The discharge destination is home (with or without support), or retirement home
- 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
Key exclusion criteria (7 listed)
- Discharged from a non-Medicine ward (e.g. medicine patient bed spaced to a surgical ward) or from the Emergency Department directly
- Previously participated in this study (in case of re-admission)
- 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.
- Died in hospital
- 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)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Care Connector care transition moduleCare Connector is an electronic interprofessional communication and collaboration tool. Its features include Physician Sign-Out, documentation, interprofessional care planner, messaging, and flow planner. The newest module is a care transition module which allows physicians to electronically generate discharge summaries as well as incorporation of allied health recommendation, but also will pull information into the PODS (Patient Oriented Discharge Summary) format designed by University Health Network. This results in a patient friendly discharge instruction sheet that can be provided to patient. The intervention arm will have access to the care transition feature, while the control wards do not. | Other | Intervention |
Primary outcome
Care transition measure 3
Time frame: Up to 30 days post discharge
This is a validated measure developed by Coleman et al (Med Care. 2008 Mar;46(3):317-22) to measure quality of care transitions. It contains 3 questions (please see reference for questions).
6 secondary outcomes
In-hospital communication
Time frame: Up to 30 days post discharge
ED visit
Time frame: 30 days post discharge
Hospitalization
Time frame: 30 days post discharge
Presence of follow up plan in discharge summary
Time frame: At the time of patient discharge (0 days)
Proportion of appointments with date/time confirmed at discharge
Time frame: At time of patient discharge (0 days)
Proportion of patients referred to community support services
Time frame: At time of patient discharge (0 days)
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Mar 2020.
- Background: PubMed 26406116Hahn-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.
- Background: PubMed 18388847Parry 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.
- Background: PubMed 29331258Tang 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.
- Canadian Patient Experiences Survey - Inpatient Care (Canadian Institute for Health Information)Link provided by the sponsor.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Terence Tang, MD principal investigator
Trillium Health Partners
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Care Connector care transition module in people with Care Transition and Communication, run by Trillium Health Partners at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 11 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Care transition measure 3 (time frame: Up to 30 days post discharge). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03970174, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Mar 2020.