Actively Recruiting
Improving TRansitions ANd OutcomeS for Heart FailurE Patients in Home Health CaRe (I-TRANSFER-HF)
Led by Weill Medical College of Cornell University · Updated on 2026-05-05
1094
Participants Needed
2
Research Sites
104 weeks
Total Duration
On this page
Sponsors
W
Weill Medical College of Cornell University
Lead Sponsor
N
National Heart, Lung, and Blood Institute (NHLBI)
Collaborating Sponsor
AI-Summary
What this Trial Is About
This study is trying to improve the hospital-to-home transition for people with heart failure who receive home care services. The study will test an intervention called I-TRANSFER-HF, which differs from usual care by combining early home health nurse visits and outpatient medical appointments. The study is interested in two questions: 1. Is I-TRANSFER-HF better than usual care at preventing heart failure patients from returning to the hospital within 30 days? 2. Are there parts of I-TRANSFER-HF that are easy or hard to implement in the real world? The researchers will answer these questions by testing the intervention among pairs of hospitals and home health agencies across the country. During the study, the hospital-agency pairs will be asked to implement I-TRANSFER-HF. The researchers will then compare the results from before and after I-TRANSFER-HF was adopted. They will also interview people from these hospitals and agencies to see how I-TRANSFER-HF is being implemented under real-world conditions.
CONDITIONS
Official Title
Improving TRansitions ANd OutcomeS for Heart FailurE Patients in Home Health CaRe (I-TRANSFER-HF)
Who Can Participate
Eligibility Criteria
You may qualify if you...
- Adults hospitalized for heart failure who transition from participating hospitals to their partner home health care agency during the study period
- Healthcare professionals involved in the transition of heart failure patients from hospital to home health care agencies and the implementation of I-TRANSFER-HF at one of the four participating hospital-home health care dyads
You will not qualify if you...
- Patients hospitalized for heart failure who are discharged home without home health care, or to inpatient rehabilitation, skilled nursing facility, or hospice
- Patients with end-stage renal disease on dialysis
- Patients with left ventricular devices
- Healthcare professionals not involved in the transition of heart failure patients from hospital to home health care agencies and the implementation of I-TRANSFER-HF at the participating hospital-home health care dyads
AI-Screening
AI-Powered Screening
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Trial Site Locations
Total: 2 locations
1
VNS Health Partners in Care
New York, New York, United States, 10017
Actively Recruiting
2
Weill Cornell Medicine
New York, New York, United States, 10021
Actively Recruiting
Research Team
M
Madeline R Sterling, MD, MPH, MS
CONTACT
How is the study designed?
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
RANDOMIZED
Model
SEQUENTIAL
Primary Purpose
HEALTH_SERVICES_RESEARCH
Number of Arms
2
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