Trial Summary
What is the purpose of this trial?
Transitions of Care (TOC) between hospital, ambulatory, and home settings for high-risk, frequently hospitalized adults with chronic diseases, such as chronic obstructive pulmonary disease (COPD) are complex, costly, and vulnerable to safety threats and poor health outcomes. One potential solution to address this gap in care is the Transitional Care Model (TCM), which utilizes a patient-centered approach with in-home interventions; since in-person in-home visits are costly, using innovative telehealth, such as virtual visits via teleconferencing may be just as effective with greater feasibility, scalability, and sustainability, particularly in the post-COVID-19 era as has been seen the rapid expansion of these technologies. With a transdisciplinary team of experts from cognitive science, care transitions/handoffs, human factors engineering, design, implementation science, and health services research, the study team proposes to implement and evaluate via a randomized clinical trial the "TELE-TOC: Telehealth Education: Leveraging Electronic Transitions Of Care for COPD patients," intervention which includes a virtual visit, pharmacy-based, in-home intervention for COPD patients to improve medication use and patient outcomes among a population at high risk for readmission and medication safety events.
Research Team
Valerie G Press, MD, MPH
Principal Investigator
University of Chicago
Eligibility Criteria
This trial is for adults aged 40 or older who have been hospitalized with a COPD exacerbation and are part of the COPD Hospital Readmission Reduction Program. It's designed to help those at high risk for readmission and medication issues.Inclusion Criteria
Exclusion Criteria
Treatment Details
Interventions
- COPD advanced practice nurse Inpatient Consult (Other)
- Inpatient Medication Reconciliation (Other)
- Post-discharge follow-up advanced practice nurse outpatient visit (Other)
- Post-discharge nurse 48 hour phone follow-up call (Other)
- Virtual At Home Medication Education Visit(s) (Behavioral Intervention)
- Virtual at Home Medication Reconciliation Visit(s) (Other)
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Chicago
Lead Sponsor
Society of Hospital Medicine
Collaborator
COPD Foundation
Collaborator
Washington University School of Medicine
Collaborator
Hospital Medicine Reengineering Network (HOMERuN)
Collaborator
The American Telemedicine Association
Collaborator
Agency for Healthcare Research and Quality (AHRQ)
Collaborator