Remote Physician Care for Home Hospital Patients

Sponsor

Brigham and Women's Hospital (Other)

Overall Status

Completed

CT.gov ID

NCT04080570

Collaborator

(none)

172

Enrollment

Locations

Arms

8.8

Actual Duration (Months)

Patients Per Site

9.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study examines the implications of providing remote physician care to home hospitalized patients compared to usual home hospital care with in-person/in-home physician visits.

Condition or Disease	Intervention/Treatment	Phase
Infection Heart Failure Chronic Obstructive Pulmonary Disease Asthma Gout Flare Chronic Kidney Diseases Hypertensive Urgency Atrial Fibrillation Rapid Anticoagulants; Increased	Other: Remote Visit	N/A

Detailed Description

Home hospital care is hospital-level care at home for acutely ill patients. In multiple publications, home hospital care delivered cost-effective, high-quality, excellent experience care with similar quality and safety as traditional hospital care. Most home hospital models require a licensed independent practitioner to see their patients physically in their home.

To further improve the efficiency and scalability of home hospital care, the investigators propose to test remote care, where the physician would provide care via a video interaction, instead of in-home/in-person care. The investigators propose a non-inferiority evaluation of this intervention.

Study Design

Study Type:

Interventional

Actual Enrollment :

172 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Remote Physician Care for Home Hospital Patients: A Randomized Controlled Trial

Actual Study Start Date :

Aug 3, 2019

Actual Primary Completion Date :

Apr 27, 2020

Actual Study Completion Date :

Apr 27, 2020

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Remote Visit After an initial physical in-home visit, the physician will see home hospitalized patients by facilitated video each day.	Other: Remote Visit After an initial in-home visit, the physician will see home hospitalized patients by facilitated video.
No Intervention: In-Home Visit The physician will see home hospitalized patients physically in their homes each day, as is usual care.

Arm

Intervention/Treatment

Experimental: Remote Visit

After an initial physical in-home visit, the physician will see home hospitalized patients by facilitated video each day.

Other: Remote Visit

After an initial in-home visit, the physician will see home hospitalized patients by facilitated video.

No Intervention: In-Home Visit

The physician will see home hospitalized patients physically in their homes each day, as is usual care.

Outcome Measures

Primary Outcome Measures

Adverse events, # [From date of admission to date of discharge (except for 30-day mortality), an expected average of 4 days]
The per patient count of adverse events, including fall, delirium, potentially preventable venous thromboembolism, new pressure ulcer, thrombophlebitis at peripheral IV site, catheter-associated urinary tract infection, new Clostridium difficile, new methicillin-resistant Staphylococcus aureus, new arrhythmia, hypokalemia, acute kidney injury, transfer back to hospital, mortality (unplanned) during admission, mortality (unplanned) 30-day post-discharge.

Secondary Outcome Measures

Unplanned readmission after index admission, y/n [Day of discharge to 30 days later]
Picker experience questionnaire, score [Day of discharge, an expected average of 4 days]
Score between 0 and 15, with higher scores signifying better experience
Global experience, score [Day of discharge, an expected average of 4 days]
Score between 0 and 10, with higher scores signifying better experience

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Resides within either a 5-mile or 20 minute driving radius of emergency department
Has capacity to consent to study OR can assent to study and has proxy who can consent
= 18 years-old
Can identify a potential caregiver who agrees to stay with patient for first 24 hours of admission. Caregiver must be competent to call care team if a problem is evident to her/him. After 24 hours, this caregiver should be available for as-needed spot checks on the patient. This criterion may be waived for highly competent patients at the patient and clinician's discretion.
Primary or possible diagnosis of cellulitis, heart failure, complicated urinary tract infection, pneumonia, COPD/asthma, other infection, chronic kidney disease, malignant pain, diabetes and its complications, gout flare, hypertensive urgency, previously diagnosed atrial fibrillation with rapid ventricular response, anticoagulation needs, or a patient who desires only medical management that requires inpatient admission, as determined by the emergency room team.

Exclusion Criteria:

Undomiciled
No working heat (October-April), no working air conditioning if forecast > 80°F (June-September), or no running water
On methadone requiring daily pickup of medication
In police custody
Resides in facility that provides on-site medical care (e.g., skilled nursing facility)
Domestic violence screen positive
Acute delirium, as determined by the Confusion Assessment Method2
Cannot establish peripheral access in emergency department (or access requires ultrasound guidance, unless point-of-care ultrasound is available)
Secondary condition: end-stage renal disease on hemodialysis, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage
Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control
Cannot independently ambulate to bedside commode, unless home-based aides are available
As deemed by on-call MD, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery
High risk for clinical deterioration
Home hospital census is full