Clinical trials: Transition Care
Transitional Care, Caregivers
Connect-Home Clinical Trial
This study will test whether transitional care targeting care needs of seriously ill, skilled nursing facility (SNF) patients and their caregivers will help to improve SNF patient outcomes (preparedness for discharge, quality of…
- Conditions
- Transitional Care, Caregivers, Patient Discharge, Aging
- Trial name
- NCT03810534
- Testing
- Connect-Home
- Where
- United States
- Volunteers
- 654 people
- Sponsor
- University of North Carolina, Chapel Hill
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
Prostate Cancer
Efficacy of a Couple-Focused mHealth Symptom Self-management Program
In this study, the investigators propose to test the efficacy of a couple-focused, web-based tailored prostate cancer symptom management program, Prostate Cancer Education and Resources for Couples (PERC) in a randomized clinical…
- Trial name
- NCT03489057
- Testing
- Prostate Cancer Education and Resources for Couples (PERC), usual care plus NCI website
- Where
- United States
- Volunteers
- 560 people, healthy volunteers welcome
- Sponsor
- UNC Lineberger Comprehensive Cancer Center
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
Traumatic Brain Injury
Brain Injury Rehabilitation Improving the Transition Experience
Each year, about 2.8 million people sustain a traumatic brain injury (TBI) in the United States, and at least 25 percent of these injuries are classified as moderate to severe.
- Trial name
- BRITE (NCT03422276)
- Testing
- Rehabilitation Discharge Plan, Rehabilitation Transition Plan
- Where
- 6 sites in United States
- Volunteers
- 1,555 people
- Sponsor
- University of Washington
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
Adverse Events, Readmissions
Relative Patient Benefits of a Hospital-PCMH Collaboration Within an ACO to Improve Care Transitions
The objective of this study is to design and implement a set of procedures (the intervention) to improve patients' experiences when they are discharged home from the hospital.
- Conditions
- Adverse Events, Readmissions, Patient Engagement
- Trial name
- NCT02130570
- Testing
- Multi-Model Intensive Discharge Intervention
- Where
- 2 sites in United States
- Volunteers
- 1,679 people
- Sponsor
- Brigham and Women's Hospital
COPD, COPD Exacerbation
Nebulizer Versus Dry Powdered Inhalers for Chronic Obstructive Pulmonary Disease (COPD)
This will be a non-blinded feasibility (pilot) study comparing triple therapy nebulizer vs dry powdered inhalers (DPI) for care transitions in Chronic obstructive pulmonary disease (COPD) exacerbation patients.
- Trial name
- NCT03219866
- Testing
- Nebulizers, Dry Powder Inhaler, Brovana
- Where
- United States
- Volunteers
- 40 people
- Sponsor
- Wake Forest University Health Sciences
Brain Injuries, Traumatic, Transitional Care
Enhancing the Transition From Hospital to Home for Patients With Traumatic Brain Injury and Families
Despite high risks of readmission and complex medical needs, there are no transitional care standards in the U.S. for patients with moderate-to-severe traumatic brain injury (TBI) discharged home from acute hospital care without…
- Conditions
- Brain Injuries, Traumatic, Transitional Care, Family Members, Patients
- Trial name
- R03 (NCT04584554)
- Testing
- BETTER Transitional Care Intervention
- Where
- United States
- Volunteers
- 31 people
- Sponsor
- Duke University
Diabetes Mellitus, Type 2, Congestive Heart Failure
Improving Patient Prioritization During Hospital-homecare Transition
This research work is focused on building and evaluating one of the first evidence-based clinical decision support tools for homecare in the United States.
- Conditions
- Diabetes Mellitus, Type 2, Congestive Heart Failure, Obstructive Pulmonary Disease, Dyspnea
- Trial name
- PREVENT (NCT04136951)
- Testing
- PREVENT clinical decision support
- Where
- 2 sites in United States
- Volunteers
- 1,915 people
- Sponsor
- Columbia University
Acute Coronary Syndrome, Heart Failure
Pharmacist Intervention to Decrease Medication Errors in Heart Disease Patients (The PILL-CVD Study)
Many people who have recently left the hospital have difficulties managing their medications, and medication errors are common. Patients with low health literacy levels may have a particularly difficult time understanding…
- Trial name
- PILL-CVD (NCT00632021)
- Testing
- Pharmacist Intervention for Low-Literacy in Cardiovascular Disease
- Where
- 2 sites in United States
- Volunteers
- 862 people
- Sponsor
- Vanderbilt University Medical Center
Chronic Disease
Home Based Care Transitions Tailored by Cognition and Patient Activation
There is overwhelming evidence that patients with multiple chronic illnesses need better self-management skills. Discharge from the hospital may not be the most opportune time to be teaching patients these self-management skills.
- Trial name
- NCT02045147
- Testing
- Grp 1a Low Cognition, Low Activation Intervention, Grp 2a Low Cognition, High Activation Intervention, Grp 3a Normal Cognition, Low Activation Intervention
- Where
- United States
- Volunteers
- 263 people
- Sponsor
- University of Nebraska
Sepsis
Implementation and Effectiveness of Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship
The purpose of this study is to evaluate if implementation of the Sepsis Transition and Recovery (STAR) program within a large healthcare system will improve outcomes for high-risk patients with suspected sepsis, while…
- Trial name
- ENCOMPASS (NCT04495946)
- Testing
- Sepsis Transition and Recovery (STAR) program, Usual care
- Where
- United States
- Volunteers
- 3,894 people
- Sponsor
- Wake Forest University Health Sciences
Gestational Diabetes, Gestational Diabetes Mellitus in Pregnancy
Clinic to Community Connections - Broader Distribution
This study addresses education needs in gestational diabetes care and followup at the staff and patient levels. In the initial phase, nurses and community health workers will complete specific training modules on gestational…
- Trial name
- NCT04474795
- Testing
- Staff -Educational training
- Where
- United States
- Volunteers
- 85 people, healthy volunteers welcome
- Sponsor
- Washington University School of Medicine
Cardiovascular Diseases, Cardiac Rehabilitation
Modified Application of Cardiac Rehabilitation for Older Adults
Modified Application of Cardiac Rehabilitation for Older Adults (MACRO) responds to a critical underuse of cardiac rehabilitation in older adults with a coaching model that addresses issues related to aging as a means to better…
- Conditions
- Cardiovascular Diseases, Cardiac Rehabilitation, Transition of Care
- Trial name
- MACRO (NCT03922529)
- Testing
- MACRO-I, Usual Care
- Where
- 3 sites in United States
- Volunteers
- 416 people
- Sponsor
- Daniel Forman, MD
Type 1 Diabetes Mellitus
Improving Health Communication During the Transition From Pediatric to Adult Diabetes Care
Adolescents and young adults (AYAs; ages 17-23) with type 1 diabetes are at high risk for negative health outcomes, including poor glycemic control and disengagement from the health care system.
- Trial name
- NCT03734107
- Testing
- Plan, Reflect, and Engage with Providers for Diabetes Care
- Where
- United States
- Volunteers
- 52 people
- Sponsor
- Children's National Research Institute
Sickle Cell Disease
Patient-Provider Tools to Improve the Transition to Adult Care in Sickle Cell Disease
The purpose of the study is to develop patient-provider clinical support tools to improve clinical practice, patient self-management, and disease outcomes in sickle cell disease during transition to adult care.
- Trial name
- iTransition (NCT02200510)
- Testing
- Self-management intervention for Adolescents with SCD, Patient Portal Intervention for Adolescents with SCD
- Where
- United States
- Volunteers
- 78 people
- Sponsor
- Children's Hospital Medical Center, Cincinnati
Acute Kidney Injury
A Study of Acute Kidney Injury in Care Transitions
This research is being done to develop materials and processes that will help facilitate education and kidney care coordination for AKI survivors.
- Trial name
- NCT05184894
- Testing
- AKI in Care Transitions (ACT) program
- Where
- United States
- Volunteers
- 50 people
- Sponsor
- Mayo Clinic
Sickle Cell Disease
LCI-HEM-SCD-ST3P-UP-001: The Sickle Cell Trevor Thompson Transition Project (ST3P-UP Study)
This multi-center study will compare the effectiveness of adding virtual peer mentoring (PM) to a structured education-based (STE) transition program for emerging adults with sickle cell disease to determine its effect on…
- Trial name
- ST3P-UP (NCT03593395)
- Testing
- Peer Mentoring [PM], Structured Education Based Transition Program STE
- Where
- 14 sites in United States
- Volunteers
- 291 people
- Sponsor
- Wake Forest University Health Sciences
Heart Transplantation
Pediatric Heart Transplantation: Transitioning to Adult Care
The purpose of this pilot trial, Transitioning to Adult Care (TRANSIT), is to develop and test an intervention (i.e., a standardized, tailored transition program focused on enhancing adherence) to improve outcomes for emerging…
- Trial name
- TRANSIT (NCT02090257)
- Testing
- TRANSIT
- Where
- 6 sites in United States
- Volunteers
- 88 people
- Sponsor
- Ann & Robert H Lurie Children's Hospital of Chicago