Value of Technology to Transfer Discharge Information

This study has been completed.
Sponsor:
Collaborator:
University of Illinois at Chicago
Information provided by (Responsible Party):
james f. graumlich, Agency for Healthcare Research and Quality (AHRQ)
ClinicalTrials.gov Identifier:
NCT00101868
First received: January 14, 2005
Last updated: April 16, 2012
Last verified: April 2012
  Purpose

The transition from hospital to home is a high-risk period in a patient's illness. Poor communication between healthcare providers at hospital discharge is common and contributes to adverse events affecting patients after discharge. The importance of good communication at discharge will increase as more primary care providers delegate inpatient care to hospitalists. Any process that improves information transfer among providers at discharge might improve the health and safety of patients discharged from U.S. hospitals each year, and to appreciably reduce unnecessary healthcare expenditures. Information transfer among healthcare providers and their patients can be undermined because of inaccuracies, omissions, illegibility, logistical failure (e.g., information is never delivered), and delays in generation (i.e., dictation or transcription) or transmission. Root causes include recall error, increased physician workloads, interface failures (e.g., physician-clerical) and poor training of physicians in the discharge process. Many of the deficiencies in the current process of information transfer at hospital discharge could be effectively addressed by the application of information technology. The proposed study will measure the value of a software application to facilitate information transfer at hospital discharge. The study is designed to compare the benefits of discharge health information technology versus usual care in high-risk patients recently discharged from acute care hospitalization. The design is a randomized, single-blind, controlled trial. The outcomes are readmission within 6 months, adverse events, and effectiveness and satisfaction with the discharge process from the patient and physician perspectives. The cost outcome is the physician time required to use the discharge software.


Condition Intervention
Information Dissemination
Interprofessional Relations
Device: Discharge communication software
Other: Usual care discharge process

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Health Services Research
Official Title: Value of Technology to Transfer Discharge Information

Further study details as provided by Agency for Healthcare Research and Quality (AHRQ):

Primary Outcome Measures:
  • Hospital Readmission, at Least One [ Time Frame: within 6 months after discharge ] [ Designated as safety issue: Yes ]
    Number of participants with at least one readmission within 6 months after discharge from index hospital visit


Secondary Outcome Measures:
  • Patients' Perception of Discharge Process, Effectiveness, Satisfaction, Preparedness [ Time Frame: 1 week after discharge ] [ Designated as safety issue: No ]
  • Patients' Perception of Discharge Process, Satisfaction [ Time Frame: 1 week after discharge ] [ Designated as safety issue: No ]
  • Pharmacist Needed to Clarify the Discharge Prescription [ Time Frame: 1 day after discharge ] [ Designated as safety issue: Yes ]
  • Pharmacist's Satisfaction With Discharge Prescription [ Time Frame: 1 day after discharge ] [ Designated as safety issue: No ]
  • At Least One Adverse Event Within One Month After Discharge [ Time Frame: 1 month after discharge ] [ Designated as safety issue: Yes ]
    Number of participants with at least one adverse event within one month after discharge

  • Patient's Satisfaction With Drug Information [ Time Frame: 1 week after discharge ] [ Designated as safety issue: No ]
  • Primary Care Physician's Perception, Effectiveness [ Time Frame: 10 days after discharge ] [ Designated as safety issue: No ]
  • Primary Care Physician's Perception, Satisfaction [ Time Frame: 10 days after discharge ] [ Designated as safety issue: No ]
  • Discharge Physician Satisfaction With Discharge Process [ Time Frame: 6 months after using discharge process ] [ Designated as safety issue: No ]
  • Number of Outpatient Visits [ Time Frame: within 6 months after discharge ] [ Designated as safety issue: No ]
  • Number of Emergency Department Visits [ Time Frame: within 6 months after discharge ] [ Designated as safety issue: Yes ]
    Number of participants with at least one emergency department visit within six months after discharge

  • Physician Time Spent to Complete the Discharge Application [ Time Frame: averaged over 2 years of patient enrollment ] [ Designated as safety issue: No ]

Enrollment: 631
Study Start Date: December 2004
Study Completion Date: August 2007
Primary Completion Date: August 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Discharge communication software
Computerized-Physician-Order-Entry software application to facilitate communication at time of hospital discharge to patients, retail pharmacists, community physicians. Software had required fields, pick lists, standard drug doses, alerts, reminders, online reference information. Software prompted discharging physician to enter pending tests, order tests after discharge. Hospital physicians used software on day of discharge to generate four documents automatically: personalized letter to outpatient physician, legible prescriptions, and legible discharge order
Device: Discharge communication software
Computerized physician order entry software used by discharging physician
Other Names:
  • Discharge assistant
  • Hospital Information Systems
  • Medical Records Systems-Computerized
  • Electronic Discharge Summary
  • Medication Reconciliation
Active Comparator: Usual care discharge process
Hospital physicians and ward nurses completed handwritten discharge forms on the day of discharge. The forms contained blanks for discharge diagnoses, discharge medications, medication instructions, post discharge activities and restrictions, post discharge diet, post discharge diagnostic and therapeutic interventions, and appointments. Patients received handwritten copies of the forms, one page of which also included medication instructions and prescriptions
Other: Usual care discharge process
Handwritten
Other Names:
  • Usual care
  • handwritten

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Inpatients at OSF Saint Francis Medical Center
  • Discharged by the hospitalist service or other inpatient services
  • High risk for poor post-discharge outcomes defined as probability of readmission (PRA) 0.4 or above

Exclusion Criteria:

  • Less than 18 years old
  • Unwilling or unable to provide written consent
  • Life expectancy less than 6 months
  • Will receive outpatient care from a primary care physician who is the same as the discharging physician
  • Do not speak English or Spanish
  • Not alert and oriented when admitted
  • Do not have telephone for post-discharge contact
  • Do not reside in Central Illinois
  • Will be discharged to a nursing home
  • Previously enrolled as subjects in the trial
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00101868

Locations
United States, Illinois
OSF Saint Francis Medical Center
Peoria, Illinois, United States, 61637
Sponsors and Collaborators
University of Illinois at Chicago
Investigators
Principal Investigator: James F Graumlich, MD University of Illinois College of Medicine
  More Information

Publications:

Responsible Party: james f. graumlich, Professor of Medicine, Agency for Healthcare Research and Quality (AHRQ)
ClinicalTrials.gov Identifier: NCT00101868     History of Changes
Other Study ID Numbers: 1RO1HS015084-01, 1RO1HS015084-02
Study First Received: January 14, 2005
Results First Received: March 18, 2012
Last Updated: April 16, 2012
Health Authority: United States: Federal Government

Keywords provided by Agency for Healthcare Research and Quality (AHRQ):
Aged
Hospitalists
Outcome and process assessment (health care)
Human
Hospitals, teaching
Physicians, family
Medical records
Quality assurance, health care
Medical errors

ClinicalTrials.gov processed this record on July 23, 2014