Clinical trials: Transitions of Care
Health Related Social Needs (HRSN), Pharmacy
Pharmacist-Led SDoH Screening Intervention During Transitions of Care in an Acute Care Setting
The study is a quasi-experimental pilot study conducted at Buffalo General Medical Center (BGMC). It aims to evaluate the feasibility, acceptability, and effectiveness of a pharmacist-led intervention addressing health-related…
- Conditions
- Health Related Social Needs (HRSN), Pharmacy, Medication Reconciliation
- Trial name
- NCT06802393
- Testing
- Intervention
- Where
- United States
- Volunteers
- 58 people
- Sponsor
- State University of New York at Buffalo
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
Psychotic Disorder
Mobile After-Care Support App: Pilot RCT
The overall aim of this program of research is to refine and test the feasibility and acceptability of a newly developed mobile device-delivered app, called Mobile After-Care Support (MACS), to improve patients' coping and…
- Trial name
- MACS-RCT (NCT03955250)
- Testing
- Mobile After-Care Support (MACS) app, Mobile app attention control
- Where
- United States
- Volunteers
- 42 people
- Sponsor
- Butler Hospital
Care Transitions, Dementia
CAPABLE Transitions: A Home Health-Based Intervention for the Hospital or Post-Acute Care Facility-to-Home Transition
This clinical study is designed to test the feasibility of a new intervention, CAPABLE Transitions. CAPABLE Transitions is based on the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) intervention designed…
- Trial name
- NCT04460742
- Testing
- CAPABLE Transitions, Home Health Agency Care
- Where
- United States
- Volunteers
- 31 people
- Sponsor
- University of Rochester
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
HIV/AIDS, Hospitalization
Re-engagement at Discharge 2
Early post-discharge mortality is high among Zambians living with HIV admitted to the hospital. This may be due to missed opportunities in post-discharge care, such as inadequate follow-up and treatment.
- Conditions
- HIV/AIDS, Hospitalization, Transitions of Care, Opportunistic Infections
- Trial name
- ReCharge2 (NCT05694546)
- Testing
- Community Health Worker Post-Discharge Intervention
- Where
- 2 sites in Zambia
- Volunteers
- 97 people
- Sponsor
- University of Maryland, Baltimore
Care Transitions
Achieving Patient-Centered Care and Optimized Health In Care Transitions by Evaluating the Value of Evidence
Funded by the Patient Centered Outcome Research Institute (PCORI), nationally recognized leaders in health care and research methods are partnering with patients and caregivers to evaluate the effectiveness of current efforts at…
- Trial name
- ACHIEVE (NCT02354482)
- Testing
- Patient Communication and Care Management, Home-Based Trust, Plain Language, and Coordination, Hospital-Based Trust, Plain Language, and Coordination
- Where
- United States
- Volunteers
- 7,939 people
- Sponsor
- Mark Williams
HIV, Hepatitis C
Criminal Justice Coordinated Transitional Care
This project aims to enroll 220 incarcerated individuals living with HIV, Hepatitis C (HCV), or history of substance misuse preparing for release into a pilot implementation study to test the feasibility and acceptability of an…
- Conditions
- HIV, Hepatitis C, Substance Use Disorders
- Trial name
- CJC-TraC (NCT05376371)
- Testing
- CJC-TraC
- Where
- 2 sites in United States
- Volunteers
- 219 people
- Sponsor
- University of Wisconsin, Madison
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
Hospitalized Patients
Supplement to Hospital to Home Outcomes
Post-discharge nurse phone call
- Trial name
- Supplement (NCT03224130)
- Testing
- Nurse Phone Call, Standard of Care
- Where
- United States
- Volunteers
- 966 people
- Sponsor
- Children's Hospital Medical Center, Cincinnati
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
Substance Use Disorders, Infection, Soft Tissue
Anchoring Sequential Intermittent Long Acting Antimicrobials With Medication for Opioid Use Disorder (MOUD) for Invasive Infections Related to Opioid Use
Standard of care for patients with opioid use disorder and complicated infections is discharge to subacute nursing facilities on IV antibiotics until completion of treatment course.
- Conditions
- Substance Use Disorders, Infection, Soft Tissue, Bacteremia, Osteomyelitis Acute
- Trial name
- AIM-STOP (NCT05521880)
- Testing
- Oritavancin
- Where
- United States
- Volunteers
- 1 people
- Sponsor
- University of Maryland, Baltimore
Acute Stroke
Michigan Stroke Transitions Trial
The Michigan Stroke Transitions Trial (MISTT) is a patient-centered randomized control trial that aims to improve the experience of stroke patients after they return home.
- Trial name
- MISTT (NCT02653170)
- Testing
- SCM, SCM and VSSP
- Where
- 3 sites in United States
- Volunteers
- 320 people
- Sponsor
- Michigan State University
Preeclampsia, Preeclampsia Severe
Nudge to Drive Transitions of Care
Hypertensive disorders of pregnancy (HDP) are stress tests which may identify women at high risk of future cardiovascular disease (CVD), the leading cause of death among women.
- Conditions
- Preeclampsia, Preeclampsia Severe, Gestational Hypertension, Hypertensive Disorder of Pregnancy
- Trial name
- REMIND (NCT04660032)
- Testing
- Nudge
- Where
- United States
- Volunteers
- 224 people
- Sponsor
- University of Pennsylvania
Focus: Hospitalized Patients
Hospital to Home Outcomes
Home Nurse Visit post discharge.
- Trial name
- NCT02081846
- Testing
- Nurse Home Visit, Standard of Care
- Where
- United States
- Volunteers
- 1,500 people
- Sponsor
- Children's Hospital Medical Center, Cincinnati
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
Stroke, Transient Ischemic Attack
Improving Coordination and Transitions of Care in Stroke Patients
This study will examine if the attending nurse model will enhance critical patient-centered elements of care that will in turn improve patient education and shared decision-making, medication adherence, stroke-related health…
- Trial name
- NCT02642744
- Testing
- Nursing care model
- Where
- United States
- Volunteers
- 670 people
- Sponsor
- University of Pennsylvania
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
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