Status:
COMPLETED
Remote Physician Care for Home Hospital Patients
Lead Sponsor:
Brigham and Women's Hospital
Conditions:
Infection
Heart Failure
Eligibility:
All Genders
18+ years
Phase:
NA
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.
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 ...
Eligibility Criteria
Inclusion
- 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
- 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
Key Trial Info
Start Date :
August 3 2019
Trial Type :
INTERVENTIONAL
Allocation :
ACTUAL
End Date :
April 27 2020
Estimated Enrollment :
172 Patients enrolled
Trial Details
Trial ID
NCT04080570
Start Date
August 3 2019
End Date
April 27 2020
Last Update
November 30 2020
Active Locations (2)
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1
Brigham and Women's Hospital
Boston, Massachusetts, United States, 02115
2
Brigham and Women's Faulkner Hospital
Boston, Massachusetts, United States, 02130