Tele-transitions of care. A 12-month, parallel-group, superiority randomized controlled trial protocol, evaluating the use of telehealth versus standard transitions of care in the prevention of avoidable hospital readmissions

Abstract

IntroductionComprehensive transitions of care, reduce dangerous hospital readmissions. Telehealth offers promise, however few guidelines aid clinicians in introducing it in a feasible way while addressing the needs of a multi-comorbid population. Physician adoptability remains a significant barrier to the use of Telehealth due to data overload, concerns for disruptive workflows and uncertain practices. The methods proposed aid clinicians in implementing Telehealth training and research with limited resources to reach patients who need clinical surveillance most. This study introduces a new workflow for addressing tele-transitions of care, using risk stratification, remote patient monitoring, and patient-centered virtual visits. We propose a new communication tool which facilitates adoption. We take a clinically meaningful approach in assessing avoidable hospital readmissions, which can lead to further quality improvements and improved patient care.MethodsThis study design is a parallel-group, superiority, randomized controlled trial in which 180 patients are enrolled in the standard of care or Telehealth arms and evaluated for 30-days post hospitalization. The Telehealth group receives daily vitals surveillance with a "teledoc", a senior resident physician, who performs weekly virtual visits. The endpoint is 30-day hospital readmission. Patient data is collected on hospital utilization, patient self-management, physician and patient experience.DiscussionOur protocol introduces a novel study design with existing clinical trainees, to provide comprehensive tele-transitions of care to reduce avoidable readmissions.

Tele-transitions of care (TTOC): a 12-month, randomized controlled trial evaluating the use of Telehealth to achieve triple aim objectives

“…1). Randomization was conducted using a computer-generated 1:1 random number allocation sequence through REDCap [22]. Eligible patients were adult patients (≥ 30 years), with 2 or more chronic disease processes, English speakers, with good cognitive function, a life expectancy greater than 6 months, with an ability to provide consent.…”

“…We introduce a feasible, replicable approach using clinical trainees and direct involvement of the patient's PCP. The protocol and study design has been published in the peer reviewed literature [22].…”

Tele-transitions of Care (TTOC). A 12-month, Randomized Controlled Trial evaluating the use of Telehealth to achieve Triple Aim Objectives.

“…A clinical summary with detailed instructions were provided by the discharge nurse. The Telehealth intervention involved the provision of a smart phone device and Bluetooth-enabled blood pressure monitoring cuff, weighing scale, and pulse oximeter within 48 hours after hospital discharge ( Figure 2) (24). Telehealth patients measured their vitals daily using the teleequipment and had weekly virtual visits with a transition of care physician (teledoc).…”

“…The aim of the study was to evaluate the effects of TTOC (weekly video visits with daily remote patient monitoring), to standard of care. The methods and study design have been previously published and are adherent to the CONSORT Statement guidelines (22,23). The primary outcome measures of the study are hospital readmissions and ED visits within 30 days of the index hospitalization discharge (Table 3).…”

“…The sample consisted of 102 patients who fulfilled the eligibility criteria, were randomized to receive either TTOC or Standard of Care ( Figure 1). Randomization was conducted using a computergenerated 1:1 random number allocation sequence through REDCap (22). Eligible patients were adult patients (≥ 30 years), with 2 or more chronic disease processes, English speakers, with good cognitive function, a life expectancy greater than 6 months, with an ability to provide consent.…”