Clinical trials: Care Transitions
Geriatric, Palliative Care
PALLIATIVE ASSESSMENT COHORT IN THE GERIATRIC EMERGENCY SETTING
The PALMA project is part of a larger palliative research program COPAL in Capital Region of Denmark led by Professor Tom Møller.
- Conditions
- Geriatric, Palliative Care, Socio-demographic Risk, Frailty at Older Adults
- Trial name
- PALMA cohort (NCT06911411)
- Testing
- Prospective observational cohort study., A prospective observational cohort study
- Volunteers
- 300 people, healthy volunteers welcome
- Sponsor
- University Hospital Bispebjerg and Frederiksberg
Colorectal Cancer, Bladder Cancer
Feasibility Testing of Patient Reported Outcomes - Informed Symptom Management System (PRISMS)
This is a proof-of-concept pilot randomized clinical trial to test the feasibility of the innovative Patient-Reported Outcomes-Informed Symptom Management System (PRISMS) to enhance personalized supportive care for cancer…
- Conditions
- Colorectal Cancer, Bladder Cancer, Ovarian Cancer, Cervical Cancer
- Trial name
- PRISMS (NCT04492007)
- Testing
- Patient-Reported Outcomes-Informed Symptom Management System (PRISMS)
- Where
- United States
- Volunteers
- 46 people
- Sponsor
- UNC Lineberger Comprehensive Cancer Center
Hospital Inpatients
An Electronic Multimedia Discharge Application
The purpose of this study is to determine whether the addition of a mobile or web based multimedia discharge application (eDischarge) to the discharge process is effective in improving patient experience, engagement, and clinical…
- Trial name
- NCT02752321
- Testing
- eDischarge
- Where
- United States
- Volunteers
- 117 people
- Sponsor
- Northwell Health
Electronic Medical Record, Transitions of Care
Structured Handoff Using Intelligent Framework for Transitions Trial
Inpatient general medicine attendings will be randomized to have an LLM feature turned on to provide a draft of an off-service handoff within Carelign (an EHR-adjacent provider communication tool).
- Conditions
- Electronic Medical Record, Transitions of Care, Physician Workflow, Artificial Intelligence (AI)
- Trial name
- SHIFT (NCT07251907)
- Testing
- LLM tool to draft handoff
- Where
- United States
- Volunteers
- 85 people
- Sponsor
- University of Pennsylvania
Pneumonia, Urinary Tract Infection
Reducing Overuse of Antibiotics at Discharge Home
The goal of this two-arm parallel cluster-randomized trial of 40 hospitals is to test the effectiveness of the ROAD Home Intervention on days of antibiotic overuse at discharge in patients hospitalized with community-acquired…
- Conditions
- Pneumonia, Urinary Tract Infection, Antibiotic Stewardship, Care Transition
- Trial name
- ROAD Home (NCT06106204)
- Testing
- ROAD Home Intervention
- Where
- United States
- Volunteers
- 40 people
- Sponsor
- University of Utah
Stroke
Stroke Transitions of Care to Reduce Hospital Length of Stay
The purpose of this prospective pilot study is to access the feasibility of Transitions of Care Coordinator (TOCC) program, to determine if the use of a TOCC will decrease hospital length of stay (LOS), and determine if…
- Trial name
- TOCC (NCT04434638)
- Testing
- Transitions of Care Coordinator, Usual Care
- Where
- United States
- Volunteers
- 40 people
- Sponsor
- Georgetown University
Prisoners, Substance Use History
Calls and Coordination for Transitions of Care at Re-entry
The goal of this clinical trial is to learn if a short program for people being released from prison can help connect them to medical care.
- Conditions
- Prisoners, Substance Use History, Chronic Medical Conditions, Psychiatric Condition
- Trial name
- Call2Care (NCT06794983)
- Testing
- In-person visit with study team member, In-person visit with NCM, Phone calls and texts
- Where
- United States
- Volunteers
- 488 people
- Sponsor
- University of Wisconsin, Madison
Blood Pressure, Transitions of Care
Role of Wrist Based Blood Pressure Monitoring in Clinical Practice
This is a pilot clinical study to test the overarching hypothesis that frequent and longitudinal blood pressure monitoring with FDA approved consumer wrist based device during the patient transition from inpatient to home to the…
- Trial name
- NCT03862742
- Where
- United States
- Sponsor
- Scripps Translational Science Institute
Heart Failure With Reduced Ejection Fraction (HFrEF)
Effectiveness of Video Monitoring and Care Transition for Heart Failure Patients (EVIT-HF): Randomized Clinical Trial
The goal of this clinical trial is to measure the effectiveness of video monitoring associated with the transition of care for patients with heart failure.
- Trial name
- EVIT-HF (NCT06731166)
- Testing
- self-care
- Where
- Brazil
- Volunteers
- 140 people
- Sponsor
- Federal University of Uberlandia
Diabetes Mellitus, Type 2, Insulin Dependent Diabetes
Diabetes Toolkit at Discharge
The purpose of this randomized clinical trial is to implement the DM Discharge Toolkit into hospital discharge and assess the effect of the DM Discharge Toolkit on patients newly requiring insulin.
- Trial name
- NCT05663931
- Testing
- DM Discharge Toolkit
- Where
- United States
- Volunteers
- 120 people
- Sponsor
- Northwestern University
Advanced Cancer, Home Care, Hospital-Based
Care Transition Intervention for Patients With Cancer
This research study is investigating an intervention called CONTINUity of care Under Management by Video visits (CONTINUUM-V). CONTINUUM-V involves a video visit with an oncology nurse practitioner within three business days of…
- Trial name
- NCT04640714
- Testing
- CONTINUity of care Under Management by Video visits (CONTINUUM-V)
- Where
- United States
- Volunteers
- 58 people
- Sponsor
- Massachusetts General Hospital
ED Patients With Chronic Medical Illnesses
An Emergency Department-To-Home Intervention to Improve Quality of Life and Reduce Hospital Use
The purpose of this study is to determine if assigning older, chronically ill patients a healthcare coach after they leave the Emergency Department (ED) improves their quality of life and reduces the need for hospital-based care.
- Trial name
- NCT02079987
- Testing
- ED-to-home care transition intervention, Usual Care
- Where
- 2 sites in United States
- Volunteers
- 1,101 people
- Sponsor
- University of Florida
Older Adults With Complex Care Needs
Digital Bridge: Using Technology to Support Patient-centered Care Transitions From Hospital to Home
Older adults who live with multiple chronic conditions are more likely to experience frequent admissions and discharges from hospital. These transitions are often challenging and leave people at risk of readmission.
- Trial name
- DB (NCT04287192)
- Testing
- Digital Bridge:Tool Intervention
- Where
- Canada
- Volunteers
- 600 people, healthy volunteers welcome
- Sponsor
- Mount Sinai Hospital, Canada
Care Transition, Communication
Care Transition Patient Experience Study With Electronic Tool
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…
- Trial name
- NCT03970174
- Testing
- Care Connector care transition module
- Where
- Canada
- Volunteers
- 240 people
- Sponsor
- Trillium Health Partners
Emergencies, Aging
Paramedic Coached ED Care Transitions to Help Older Adults Maintain Their Health
The emergency department (ED) is a common source of acute illness care for older adults. Many older adults who are discharged home from the ED return within 30 days due to numerous challenges faced during the ED-to-home…
- Trial name
- NCT02520661
- Testing
- Care Transitions Intervention
- Where
- 2 sites in United States
- Volunteers
- 1,979 people
- Sponsor
- University of Wisconsin, Madison
Schizophrenia, Medical Complication
Adapting Critical Time Intervention to Support Inpatient Medical Care Transition
We are pursuing a pilot study to assess the feasibility and preliminary effectiveness of adapting a critical time intervention (CTI) approach for adults with schizophrenia who have been admitted for the inpatient treatment of…
- Trial name
- NCT03637296
- Testing
- Critical time intervention
- Where
- 2 sites in United States
- Volunteers
- 15 people
- Sponsor
- New York State Psychiatric Institute
LTC-to-hospital Transfer Decision-making
Evaluation of the STEP Intervention for Long-Term Care Residents Facing Hospital Transfer Decisions
This trial will evaluate whether the Supporting Transitions and Empowering Preferences (STEP) toolkit can improve decision-making about hospital transfers in long-term care residents and their substitute decision-makers and…
- Trial name
- STEP (NCT07153341)
- Testing
- STEP Decision Support Toolkit
- Where
- 2 sites in Canada
- Volunteers
- 200 people
- Sponsor
- Bruyère Health Research Institute.
Cerebral Palsy
Respiratory Exacerbation Plans for Action and Care Transitions for Children With Severe CP
This study will pilot test a just-in-time (JIT) adaptive intervention to reduce severe respiratory illness, for children with severe cerebral palsy (CP).
- Trial name
- RE-PACT (NCT05292365)
- Testing
- RE-PACT Intervention
- Where
- 2 sites in United States
- Volunteers
- 60 people
- Sponsor
- University of Wisconsin, Madison
Colorectal Surgery, Care Transition
Optimizing Care Transition Process for Older Colorectal Surgery Patients
The goal of this study to test if a care transition intervention designed for older colorectal surgery patients would improve outcomes after discharge. It will assess the feasibility of the intervention.
- Conditions
- Colorectal Surgery, Care Transition, Older Adults (65 Years and Older)
- Trial name
- NCT06752031
- Testing
- OSCAR-S Care Transition Model
- Where
- United States
- Volunteers
- 30 people
- Sponsor
- Massachusetts General Hospital
Test Result Management
An Automatic Notification System for Test Results Finalized After Discharge
Specific Aims: (Study #1, funded by AHRQ, completed May 2011) 1. To create an automatic notification system to prompt physicians of test results finalized after discharge. 2.
- Trial name
- NCT01153451
- Testing
- Email Notification
- Where
- United States
- Volunteers
- 441 people
- Sponsor
- Brigham and Women's Hospital