Pragmatic Clinical Trial to Improve Patient Experience Among Adults During Transitions from Hospital to Home: the PArTNER study

Abstract

INTRODUCTION: Minority-serving hospitals (MSHs) need evidence-based strategies tailored to the populations they serve to improve patient-centered outcomes after hospitalization. METHODS: We conducted a pragmatic randomized clinical trial (RCT) from October 2014 to January 2017 at a MSH comparing the effectiveness of a stakeholdersupported Navigator intervention vs. Usual care on posthospital patient experience, outcomes, and healthcare utilization. Community health workers and peer coaches delivered the intervention which included (1) in-hospital visits to assess barriers to health/healthcare and to develop a personalized Discharge Patient Education Tool (DPET); (2) a home visit to review the DPET; and (3) telephone-based peer coaching. The co-primary outcomes were between-group comparisons of 30-day changes in Patient-Reported Outcomes Measurement Information System (PROMIS) measures of anxiety and informational support (minimum important difference is 2 to 5 units change); a p-value <0.025 was considered significant using intention-to-treat analysis. Secondary outcomes included death, ED visits, or readmissions and measures of emotional, social, and physical health at 30 and 60 days. RESULTS: We enrolled 1029 adults hospitalized with heart failure (28%), pneumonia (22%), MI (10%), COPD (11%), or sickle cell disease (29%). Over 80% were non-Hispanic Black. Overall, there were no significant between-group differences in the 30-day change in anxiety (adjusted difference: −1.6, 97.5% CI −3.3 to 0.1, p=0.03), informational support (adjusted difference: −0.01, 97.5% CI −2.0 to 1.9, p=0.99), or any secondary outcomes. Exploratory analyses suggested the Navigator intervention improved anxiety among participants with COPD, a primary care provider, a hospitalization in the past 12 months, or higher baseline anxiety; among participants without health insurance, the intervention improved informational support (all p-values <0.05). CONCLUSIONS: In this pragmatic RCT at a MSH, the Navigator intervention did not improve post-hospital anxiety, informational support, or other outcomes compared to Usual care. Benefits observed in participant subgroups should be confirmed in future studies. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02114515

Systematic review of contemporary interventions for improving discharge support and transitions of care from the patient experience perspective

“…One pragmatic clinical trial assessed the impact of a transitional care intervention from the hospital to the community, supported by community health workers and peer coaches [ 41 ]. Table 5 summarizes the methods, context, risk-of-bias assessment, intervention, and results.…”

“…The only study (i.e., pragmatic trial) of a transitional support, specifically a navigator program, did not demonstrate increased effectiveness compared to usual care, although it may have had specific advantages for those who were uninsured [ 41 ]. Similar to other types of complex interventions, the quality and results of studies of transitional care interventions may benefit from improved implementation fidelity and intervention adaptability to emergent or context-specific patient needs and preferences–beyond a one-size-fits-all approach [ 41 , 53 , 54 ]. Additionally, tailored measures are needed to improve the formal assessment of patient experience with care that encompass transitional supports provided at home [ 55 , 56 ].…”