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An emergency department-to-home intervention to improve quality of life and reduce hospital use
Investigator (PI): Carden, Donna
Performing Organization (PO): (Current): University of Florida, College of Medicine, Department of Emergency Medicine / (352) 265-5911
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2014
Final Year: 2018
Record Source/Award ID: PCORI/IHS-1306-01451
Funding: Total Award Amount: $2,032,459
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Number of Subjects: 1320
Abstract: Emergency department (ED)-to-home transitions for patients with chronic medical conditions are often poorly managed, leading to confusion and anxiety among patients and, ultimately, return to the ED itself as well as hospital admission. The result of this cycle is poor quality of life for patients and an ever-increasing total cost of ED visits and hospital admissions. The nature of the ED, with its emphasis on speedy thoroughfare and hand-off of health care, leaves it wanting in terms of adequate ways to handle the transition from ED to home. Addressing patient concerns, such as where to follow up for chronic conditions, how to deal with changes in medications, and what to expect at the next site of care, are largely pushed aside in favor of ensuring rapid patient turnover in the busy ED. The fact that the ED also acts as the safety net for many vulnerable patients, such as minorities, the poor, and older patients with multiple chronic health problems, magnifies the urgency of this shortcoming. If the proper transition of patients out of the ED is needed to break this cycle of repeated ED visits and hospital admissions, then a patient-centered intervention at this critical time frame may lead to improvements in quality of life, health care quality, and overall health care costs. Patients and other members of our research team suggest that a community-based social-support and medical follow-up system after ED discharge has the potential to accomplish these goals. We plan to compare this community-based social- and medical-support system to the usual ED practice of giving verbal and written discharge instructions on quality of life and need for return trips to the ED and hospital admissions. We will make this comparison in older, chronically ill patients (Medicare beneficiaries) who are treated and discharged to home from the ED. We will also interview patients to determine how the community-based support system helps them make decisions about managing their health problems and when and where to seek additional care. These results are important because they represent an improvement in the quality, patient-centeredness, and health care outcomes of current post-ED transitions. More on this project: In Care Transitions, a Chance to Make or Break Patients' Recovery--A narrative on what happens when patients are harmed by poorly executed transitions between healthcare settings. https://www.pcori.org/research-in-action/care-transitions-chance-make-or-break-patients-recovery
MeSH Terms:
  • Aged
  • Chronic Disease
  • Community Health Services
  • Continuity of Patient Care
  • Emergency Service, Hospital /*organization & administration
  • Health Care Costs
  • * Hospitalization
  • Humans
  • Medicare
  • Minority Groups
  • Outcome Assessment, Health Care
  • Patient Admission
  • Patient-Centered Care
  • Quality of Life
  • United States
  • Vulnerable Populations
Country: United States
State: Florida
Zip Code: 32610
UI: 20143566
CTgovId: NCT02079987
Project Status: Completed
Record History: ('2017: Project extended to 2018',)