Trial · NCT02130570
Relative Patient Benefits of a Hospital-PCMH Collaboration Within an ACO to Improve Care Transitions
NCT02130570, Not applicable, Completed, Brigham and Women's Hospital; results first posted 2019-08-20
3 sourcestrials-2026-11-12-0.5.0
Download JSON
Cite this record
ConductScience Library. Relative Patient Benefits of a Hospital-PCMH Collaboration Within an ACO to Improve Care Transitions. Trials, record NCT02130570. Release trials-2026-11-12-0.5.0, 12 Nov 2026. https://conductscience.org/library/trials/NCT02130570
On this page
Trial
As registered on ClinicalTrials.gov, in the graph's capture of the registry.
- Title
- Relative Patient Benefits of a Hospital-PCMH Collaboration Within an ACO to Improve Care Transitions
- NCT number
- NCT02130570
- Status
- Completed
- Phases
- Not applicable
- Enrollment
- 1,679 participants, actual
- Lead sponsor
- Brigham and Women's Hospital
- Conditions
- Adverse Events, Readmissions, Patient Engagement
- Interventions
- Multi-Model Intensive Discharge Intervention
- First posted
- 2014-05-05
- Last updated
- 2019-08-20
- Results first posted
- 2019-08-20
Source ClinicalTrials.gov
Registered outcomes6
Each outcome the trial registered, primary first, in ClinicalTrials.gov's words.
| List | Outcome | Time frame | Description |
|---|---|---|---|
| Primary | Proportion of Participants With an Adverse Event Within 30 Days After Index Discharge Date | 30 days after discharge | Proportion of Participants With an Adverse Event Within 30 Days after Index Discharge Date |
| Secondary | Proportion of Participants With New or Worsening Signs/Symptoms Within 30 Days of Discharge | 30 days after discharge | New or worsening signs or symptoms, i.e. unpleasant symptoms, loss of function, abnormal lab results, and/or additional medical care within 30 days after discharge. |
| Secondary | Number of Patients With a Nonelective Readmission Within 30 Days of the Index Discharge Date | 30 days after discharge | Nonelective readmission within 30 days of the index discharge date |
| Secondary | Change in Functional Status on the Modified Medical Outcomes Survey Short Form-12 (SF-12v2) From One Month Prior to Admission to 30 Days After Discharge. | One month prior to admission to 30 days after discharge. | During the inpatient enrollment period, patients will complete a modified Medical Outcomes Survey Short Form-12 (SF-12v2). The SF-12v2 measures a patient's functional status and health-related quality of life one month prior to admission. 30 days after discharge, SF12 questions will be repeated so that functional status and health-related quality of life can be compared to prior to admission. This measure is a 12-item measure. Each item 5 possible responses with a value from 1 to 5 (with higher scores indicating worse outcomes). A summary score is computed by summing the score on each item. Therefore, the range of summary scores for the SF-12v2 is a minimum of 12 and a maximum of 60. |
| Secondary | Proportion of Participants With Positive Responses Regarding Patient Engagement and Opinions of the Discharge Process | 30 days after discharge | During the 30 day post-discharge follow-up phone call we asked patients about their participation in, understanding of, and ability to carry out the post-discharge plan. These questions include questions from the Interpersonal Processes of Care survey and several additional questions from the HOMERUN study of readmitted patients. In the table below, we have abbreviated each survey question since the number of characters is limited in this field in the table. We have pasted below the full survey question. 1. When you were getting ready to leave the hospital one month ago, how often did your care team use medical terminology that you did not understand? 2. How often did you feel confused about what was going on with your medical care because they did not explain things well? 3. How often did they give you enough time to say what you thought was important regarding your medical care? 4. How often did they listen carefully to what you had to say? 5. How often did you feel p |
| Secondary | Post-Discharge Health Care Utilization | 30 days after discharge | We will measure emergency department visits and hospital readmissions within 30 days of discharge using a combination of administrative data for all Partners hospitals plus patient report for all utilization outside the Partners system. |
Source ClinicalTrials.gov
Outcomes6
Each outcome the trial posted results for, in ClinicalTrials.gov's words.
| Type | Outcome | Time frame | Population | Units | Measured as |
|---|---|---|---|---|---|
| PRIMARY | Proportion of Participants With an Adverse Event Within 30 Days After Index Discharge Date | 30 days after discharge | 1679 participants were enrolled in the study, however, 22 patients were lost to follow-up and therefore not included in the analysis (e.g., patient withdrew consent, patient died during index admission). | proportion of participants | NUMBER |
| SECONDARY | Proportion of Participants With New or Worsening Signs/Symptoms Within 30 Days of Discharge | 30 days after discharge | 1679 participants were enrolled in the study, however, 22 patients were lost to follow-up and therefore not included in the analysis (e.g., patient withdrew consent, patient died during index admission). | proportion of participants | NUMBER |
| SECONDARY | Number of Patients With a Nonelective Readmission Within 30 Days of the Index Discharge Date | 30 days after discharge | 1679 participants were enrolled in the study, however, 22 patients were lost to follow-up and therefore not included in the analysis (e.g., patient withdrew consent, patient died during index admission). | participants | NUMBER |
| SECONDARY | Change in Functional Status on the Modified Medical Outcomes Survey Short Form-12 (SF-12v2) From One Month Prior to Admission to 30 Days After Discharge. | One month prior to admission to 30 days after discharge. | 1679 participants were enrolled in the study, however, 22 patients were lost to follow-up and therefore not included in the analysis (e.g., patient withdrew consent, patient died during index admission). | units on a scale | MEAN |
| SECONDARY | Proportion of Participants With Positive Responses Regarding Patient Engagement and Opinions of the Discharge Process | 30 days after discharge | 1679 participants were enrolled in the study, however, 22 patients were lost to follow-up and therefore not included in the analysis (e.g., patient withdrew consent, patient died during index admission). Not all patients answered the 30-day patient survey. | proportion of participants | NUMBER |
| SECONDARY | Post-Discharge Health Care Utilization | 30 days after discharge | Post Discharge ED visits within 30 days of discharge were not able to be obtained from the second site MGH. Post discharge readmissions were obtained, however, without the ED visit data from MGH we are unable to create a count for Post-Discharge Health Care Utilization (ED plus readmissions). |
Source ClinicalTrials.gov
Results by group34
Each measurement the trial posted, group by group, in the words and numbers it posted.
| Outcome | Group | Category | Value | Spread | Units |
|---|---|---|---|---|---|
| Proportion of Participants With an Adverse Event Within 30 Days After Index Discharge Date | Multi-Model Intensive Discharge Program | 0.18 | 95% Confidence Interval 0.15 to 0.21 | proportion of participants | |
| Proportion of Participants With an Adverse Event Within 30 Days After Index Discharge Date | Usual Care | 0.23 | 95% Confidence Interval 0.20 to 0.27 | proportion of participants | |
| Proportion of Participants With New or Worsening Signs/Symptoms Within 30 Days of Discharge | Multi-Model Intensive Discharge Program | 0.90 | 95% Confidence Interval 0.86 to 1.01 | proportion of participants | |
| Proportion of Participants With New or Worsening Signs/Symptoms Within 30 Days of Discharge | Usual Care | 0.92 | 95% Confidence Interval 0.85 to 0.97 | proportion of participants | |
| Number of Patients With a Nonelective Readmission Within 30 Days of the Index Discharge Date | Multi-Model Intensive Discharge Program | 107 | participants | ||
| Number of Patients With a Nonelective Readmission Within 30 Days of the Index Discharge Date | Usual Care | 78 | participants | ||
| Change in Functional Status on the Modified Medical Outcomes Survey Short Form-12 (SF-12v2) From One Month Prior to Admission to 30 Days After Discharge. | Multi-Model Intensive Discharge Program | 47.25 | Standard Deviation 7.85 | units on a scale | |
| Change in Functional Status on the Modified Medical Outcomes Survey Short Form-12 (SF-12v2) From One Month Prior to Admission to 30 Days After Discharge. | Usual Care | 46.14 | Standard Deviation 8.11 | units on a scale | |
| Proportion of Participants With Positive Responses Regarding Patient Engagement and Opinions of the Discharge Process | Multi-Model Intensive Discharge Program | Used medical terminology you did not understand | .86 | proportion of participants | |
| Proportion of Participants With Positive Responses Regarding Patient Engagement and Opinions of the Discharge Process | Usual Care | Used medical terminology you did not understand | .85 | proportion of participants |
1 to 10 of 34Source ClinicalTrials.gov
See all 34 results by groupParticipant flow6
How many started, completed or left each group, period by period.
| Period | Milestone | Group | Participants | Units counted |
|---|---|---|---|---|
| Overall Study | STARTED | Multi-Model Intensive Discharge Program | 987 | |
| Overall Study | STARTED | Usual Care | 692 | |
| Overall Study | COMPLETED | Multi-Model Intensive Discharge Program | 978 | |
| Overall Study | COMPLETED | Usual Care | 679 | |
| Overall Study | NOT COMPLETED | Multi-Model Intensive Discharge Program | 9 | |
| Overall Study | NOT COMPLETED | Usual Care | 13 |
Source ClinicalTrials.gov
Adverse events0
Each adverse event the trial posted, group by group: the participants affected out of those at risk.
None in this release.
Adverse event totals6
The totals the trial posted for each group.
| Total | Group | Affected | At risk |
|---|---|---|---|
| Total, all-cause mortality | Multi-Model Intensive Discharge Program | ||
| Total, all-cause mortality | Usual Care | ||
| Total, other adverse events | Multi-Model Intensive Discharge Program | 0 | 978 |
| Total, other adverse events | Usual Care | 0 | 679 |
| Total, serious adverse events | Multi-Model Intensive Discharge Program | 0 | 978 |
| Total, serious adverse events | Usual Care | 0 | 679 |
Source ClinicalTrials.gov
Papers0
The papers the trial lists on ClinicalTrials.gov.
None in this release.
Grants0
The grants NIH RePORTER links to the trial, newest funded first: NIH's, and some of AHRQ's, CDC's, FDA's and VA's. Each shows its title, principal investigators, organization and funder in its newest year.
None in this release.
Trial comparisons2
Comparisons of the trial's two groups, calculated by ConductScience from the counts it posted.
| Comparison | Source |
|---|---|
| Multi-Model Intensive Discharge Program vs Usual Care: Number of Patients With a Nonelective Readmission Within 30 Days of the Index Discharge Date | Trial comparisons |
| Multi-Model Intensive Discharge Program vs Usual Care: serious adverse events | Trial comparisons |
Tests0
The ConductCognition tests this trial's registered outcomes name, as ScienceGraph matched them in trial-tests-2026-11-12-0.2.1.
None in this release.
Data dates
The day each source was copied for this release.
Sources 3
- ClinicalTrials.gov's posted results, through CTTI's AACTFreely available. Acknowledgement requested
- ClinicalTrials.govNo license stated
- NIH RePORTER's clinical studies and project filesPublic domain
Each source's terms
- ClinicalTrials.gov's posted results, through CTTI's AACTClinicalTrials.gov data via Aggregate Analysis of ClinicalTrials.gov (AACT), CTTI. CTTI makes its materials freely available and requests acknowledgement. https://aact.ctti-clinicaltrials.org/documentation/299
- ClinicalTrials.govnone stated
- NIH RePORTER's clinical studies and project filesPublic domain (NIH RePORTER)
ClinicalTrials.gov's data carry an international copyright outside the United States: https://clinicaltrials.gov/about-site/terms-conditions.
For software
Read this trial from software.
The record and each of its lists are JSON, twenty rows a page. No key.
GET https://conductscience.org/api/trials/v1/NCT02130570
GET https://conductscience.org/api/trials/v1/NCT02130570/results?page=2