Clinical trials: Transitions of Care
Diabetes Mellitus, Type 2, Insulin Dependent Diabetes
Diabetes Toolkit at Discharge
The purpose of this randomized clinical trial is to implement the DM Discharge Toolkit into hospital discharge and assess the effect of the DM Discharge Toolkit on patients newly requiring insulin.
- Trial name
- NCT05663931
- Testing
- DM Discharge Toolkit
- Where
- United States
- Volunteers
- 120 people
- Sponsor
- Northwestern University
Appointments and Schedules
Post-Discharge Follow-up Appointment Scheduling
This is a prospective clinical trial evaluating whether a behaviorally informed intervention (pre-discharge iPad video scheduling) increases post-discharge primary care physician (PCP) appointment completion compared to the…
- Trial name
- NCT06387576
- Testing
- Behaviorally informed pre-discharge iPad video scheduling
- Where
- United States
- Volunteers
- 41 people
- Sponsor
- University of California, Los Angeles
Chronic Obstructive Pulmonary Disease (COPD)
Utility of Remote Lung Auscultation in Transitions of Care After Pulmonary Exacerbations of COPD
Listening to breath sounds with the stethoscope/auscultation is used by pulmonary physicians in conjunction with pulmonary function, signs and symptoms, oxygen saturation and diagnostic testing to admit, follow and discharge…
- Trial name
- NCT05661435
- Testing
- RESP Biosensor
- Where
- 2 sites in United States
- Sponsor
- Strados Labs, Inc.
Patient Discharge, Emergency Care
Trial of Emergency Department Discharge With Enhanced Transitions of Care Compared to Usual Care
This is a randomized controlled trial to assess the relative effectiveness of providing Enhanced Transitions of Care (ETOC) to improve patient outcomes after discharge from the Emergency Department (ED).
- Trial name
- ETOC (NCT02533856)
- Testing
- ETOC
- Volunteers
- 316 people
- Sponsor
- Thomas Jefferson University
HIV/AIDS, Hospitalization
Re-engagement at Discharge 2
Early post-discharge mortality is high among Zambians living with HIV admitted to the hospital. This may be due to missed opportunities in post-discharge care, such as inadequate follow-up and treatment.
- Conditions
- HIV/AIDS, Hospitalization, Transitions of Care, Opportunistic Infections
- Trial name
- ReCharge2 (NCT05694546)
- Testing
- Community Health Worker Post-Discharge Intervention
- Where
- 2 sites in Zambia
- Volunteers
- 97 people
- Sponsor
- University of Maryland, Baltimore
Stroke Prevention, Blood Pressure Reduction
STEPs to Blood Pressure Reduction.
The Stroke Transitions Education and Prevention (STEP) Clinic is a new type of clinic designed for stroke patients and was established to provide a comprehensive approach to stroke risk factor reduction.
- Trial name
- STEPS (NCT02591394)
- Testing
- STEP Clinic, Usual Care
- Where
- United States
- Volunteers
- 115 people
- Sponsor
- The University of Texas Health Science Center, Houston
Transitional Care Coordination, Home Visits
Collaborative Home Visits to Reduce Hospital Readmissions and Improve Medication Use During Transitions of Care
The primary objective is to develop a sustainable practice model emphasizing home visits by a collaborative physician and pharmacist team to decrease unplanned emergency department visits and hospital readmissions at 30 and 90…
- Trial name
- NCT02087072
- Testing
- Collaborative visit with provider and pharmacist
- Where
- United States
- Sponsor
- Ohio State University
Medication Adherence
Electronic Medication Adherence Reporting and Feedback During Care Transitions
Patients often have problems with their medications after leaving the hospital and going back home. The goals of this study are to provide a special electronic pill-box with pre-filled weekly medication trays that can alert…
- Trial name
- NCT03475030
- Testing
- pre-filled medication trays, automated medication reminders
- Where
- United States
- Volunteers
- 207 people
- Sponsor
- Brigham and Women's Hospital
Health Services Research, Prisons, Delivery of Health Care, Vulnerable Populations, Community Health Aides
Evaluation of Transitions Clinic: A Post-Release Clinic for Recently Released Parolees With Chronic Medical Conditions
The purpose of this study is to study the effectiveness of the Transitions Clinic, a post-release clinic for parolees with chronic medical conditions, in achieving increased primary care engagement, lower rates of inappropriate…
- Trial name
- NCT01179035
- Testing
- Transitions Clinic - parolee-targeted care, Expedited Primary Care
- Where
- United States
- Volunteers
- 150 people
- Sponsor
- Transitions Clinic
Critical Illness, Transitions of Care
Evaluating the Effectiveness of an Electronic Medical Transfer Tool to Improve Communication During Transfers From ICU
The transfer of patients from the intensive care unit (ICU) to a medical or surgical hospital ward is a particularly high risk transfer that may expose patients to complications or adverse events if there are communication…
- Trial name
- NCT03590002
- Testing
- Electronic ICU Medical Transfer Tool
- Where
- 4 sites in Canada
- Volunteers
- 1,751 people
- Sponsor
- Henry T. Stelfox, MD PhD
Heart Failure With Preserved Ejection Fraction
Transitions of Care Clinic (TOCC)
The transition period from hospital to home is a time of heightened risk for patients to experience adverse events, medication errors, and readmission to the hospital.
- Trial name
- NCT06937827
- Testing
- HF Kit and Follow-ups
- Where
- United States
- Volunteers
- 69 people
- Sponsor
- Hackensack Meridian Health
Acute Stroke
Michigan Stroke Transitions Trial
The Michigan Stroke Transitions Trial (MISTT) is a patient-centered randomized control trial that aims to improve the experience of stroke patients after they return home.
- Trial name
- MISTT (NCT02653170)
- Testing
- SCM, SCM and VSSP
- Where
- 3 sites in United States
- Volunteers
- 320 people
- Sponsor
- Michigan State University
Patient Navigation
Empowering Families of Migrant Children and Youth with Special Healthcare Needs
The goal of this randomized controlled trial is to test if a patient navigator program improves healthcare experiences and outcomes for migrant families caring for a child or youth with special healthcare needs (i.e.
- Trial name
- MiNav (NCT06373588)
- Testing
- Patient Navigator
- Where
- 3 sites in Canada
- Volunteers
- 324 people
- Sponsor
- McGill University Health Centre/Research Institute of the McGill University Health Centre
Medication Reconciliation
Evaluation of Pharmacist-led Medication Reconciliation Service Benefits in Hospitalised Medical Patients
Background: Transitions of care often lead to medication errors and unnecessary healthcare utilisation. It has been repeatedly shown that medication reconciliation can at least partially reduce this risk.
- Trial name
- NCT06207500
- Testing
- Pharmacist-led Medication Reconciliation
- Where
- Slovenia
- Volunteers
- 553 people
- Sponsor
- The University Clinic of Pulmonary and Allergic Diseases Golnik
Hospital Readmissions
Enhancing the Care Transitions Intervention With Peer Support to Reduce Disparities
Unplanned hospital readmissions are extremely costly to patients and our healthcare system. Being readmitted to the hospital also leads to increased risk of health complications for patients including infections and impairments…
- Trial name
- NCT04981977
- Testing
- Care Transitions Intervention, Care Transitions Intervention and Peer Support, Usual Care
- Where
- United States
- Volunteers
- 483 people, healthy volunteers welcome
- Sponsor
- University of South Florida
Preeclampsia
Use of Allied-health Professionals to Improve Treatment of Disease
The goal of this clinical trial is to learn if allied-health professionals can recruit and follow research participants, sustain engagement, and improve and diagnose treatment of diseases by facilitating transitions of care.
- Trial name
- NCT06337799
- Testing
- Research Pharmacist
- Volunteers
- 200 people
- Sponsor
- University of Iowa
Hospitalization
Care Transitions Innovation (C-TraIn)
The purpose of this protocol is to evaluate the Care Transitons Innovation, a quality improvement project being implemented at OHSU to improve the transition from hospital to home for uninsured and Medicaid patients admitted to…
- Trial name
- NCT01906645
- Testing
- Care Transitions Innovation (C-TraIn)
- Where
- United States
- Volunteers
- 382 people
- Sponsor
- Oregon Health and Science University
Bipolar Disorder, Major Depression
Effectiveness of mHealth Post-discharge Intervention for Patients With Severe Mental Illness
The overall aim of this program of research is to improve the continuity of care for patients with serious mental illness (SMI) by supporting a safer and more efficient bridge from hospital to outpatient care using a mobile…
- Conditions
- Bipolar Disorder, Major Depression, Schizophrenia
- Trial name
- tFOCUS (NCT05703412)
- Testing
- Transition-FOCUS mHealth Intervention, Check-In
- Where
- United States
- Volunteers
- 180 people
- Sponsor
- Butler Hospital
Transitional Care, Caregivers
Connect-Home Clinical Trial
This study will test whether transitional care targeting care needs of seriously ill, skilled nursing facility (SNF) patients and their caregivers will help to improve SNF patient outcomes (preparedness for discharge, quality of…
- Conditions
- Transitional Care, Caregivers, Patient Discharge, Aging
- Trial name
- NCT03810534
- Testing
- Connect-Home
- Where
- United States
- Volunteers
- 654 people
- Sponsor
- University of North Carolina, Chapel Hill
Health Related Social Needs (HRSN), Pharmacy
Pharmacist-Led SDoH Screening Intervention During Transitions of Care in an Acute Care Setting
The study is a quasi-experimental pilot study conducted at Buffalo General Medical Center (BGMC). It aims to evaluate the feasibility, acceptability, and effectiveness of a pharmacist-led intervention addressing health-related…
- Conditions
- Health Related Social Needs (HRSN), Pharmacy, Medication Reconciliation
- Trial name
- NCT06802393
- Testing
- Intervention
- Where
- United States
- Volunteers
- 58 people
- Sponsor
- State University of New York at Buffalo