Harriette G.C. Van Spall|Shun Fu Lee|Feng Xie|Urun Erbas Oz|Richard Perez|Peter R. Mitoff|Manish Maingi|Michael C. Tjandrawidjaja|Michael Heffernan|Mohammad I. Zia|Liane Porepa|Mohamed Panju|Lehana Thabane|Ian D. Graham|R. Brian Haynes|Dilys Haughton|K Simek|Dennis T. Ko|Stuart J. Connolly
Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure
McMaster University|Impact|Population Health Research Institute|Population Health Research Institute|McMaster University|Impact|Centre for Health Evaluation and Outcome Sciences|Institute for Clinical Evaluative Sciences|Institute for Clinical Evaluative Sciences|University of Toronto|St Joseph's Health Centre|Trillium Health Centre|William Osler Health System|HalTech|University of Toronto|Toronto East General Hospital|Southlake Regional Health Center|McMaster University|McMaster University|Impact|University of Ottawa|McMaster University|Impact|Home and Community Care Support Services|Population Health Research Institute|Institute for Clinical Evaluative Sciences|University of Toronto|McMaster University|Population Health Research Institute
h3importanceh3 health care services support hospitaltohome transition improve outcomes patients heart failure hf h3objectiveh3 test effectiveness patientcentered care transitions hf transitional care model patients hospitalized hf h3design setting participantsh3 steppedwedge cluster randomized trial 2494 adults hospitalized hf across 10 hospitals ontario canada february 2015 march 2016 followup november 2016 h3interventionsh3 hospitals randomized receive intervention n 1104 patients nurseled selfcare education structured hospital discharge summary family physician followup appointment less 1 week discharge highrisk patients structured nurse homevisits heart function clinic care provided patients usual care n 1390 patients transitional care left discretion clinicians h3main outcomes measuresh3 primary outcomes hierarchically ordered composite allcause readmission emergency department ed visit death 3 months composite allcause readmission ed visit 30 days secondary outcomes bprepared score discharge preparedness range 0 prepared 22 least prepared 3item care transitions measure ctm3 quality transition range 0 worst transition 100 best transition 5level eq5d version eq5d5l quality life range 0 dead 1 full health qualityadjusted lifeyears qaly range 0 dead 05 full health 6 months h3resultsh3 among eligible patients 2494 mean age 777 years 1258 504 women completed trial significant difference intervention usual care groups first primary composite outcome 545 494 vs 698 502 events respectively hazard ratio hr 099 95 ci 083119 second primary composite outcome 304 275 vs 408 293 events respectively hr 093 95 ci 073118 significant differences intervention usual care groups secondary outcomes mean bprepared score 6 weeks 166 vs 139 difference 265 95 ci 137392ipi lt 001 mean ctm3 score 6 weeks 765 vs 703 difference 616 95 ci 0901143ipi 02 mean eq5d5l score 6 weeks 07 vs 07 difference 006 95 ci 001 011ipi 02 6 months 07 vs 06 difference 006 95 ci 001012ipi 02 significant difference mean qaly groups 6 months 03 vs 03 difference 000 95 ci 002 002ipi 98 h3conclusions relevanceh3 among patients hf ontario canada implementation patientcentered transitional care model compared usual care improve composite clinical outcomes whether type intervention could effective health care systems locations would require research h3trial registrationh3 clinicaltrialsgov identifiernct02112227