A RCT to Reduce Cardiopulmonary Rehospitalizations

Boston Medical Center, Boston MA

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Abstract

A RCT to Reduce Cardiopulmonary Re-hospitalizations Background: Limited health literacy is prevalent in America and has been identified as a cross-cutting priority area for transforming health care quality. We explore the effect of innovative patient-education and self-management systems on early re-hospitalization for patients with chronic cardiopulmonary diseases. Design: Three-armed block-randomized RCT for patients with chronic cardiopulmonary diseases in three levels of Health Literacy. Hypotheses: (1) An intervention specifically designed for patients with limited health literacy will reduce the rate of early re-hospitalization for patients with cardiopulmonary diseases among an urban, medically underserved patient population; and (2) This intervention will be especially effective in lowering the early re-hospitalization rate among those patients with low health literacy. Methods: After adapting and testing the intervention, 750 patients, admitted to the general adult medical service of Boston Medical Center will be tested with the Rapid Estimate of Adult Literacy in Medicine (<6th grade, 7th-8th grade, >9lh grade), enrolled, and block randomized into three groups (1) those receiving usual care (Control Group); (2) those receiving comprehensive hospital discharge from a case manager using up-to-date guidelines for cardiopulmonary diseases, and a written discharge plan sent to their primary care and consulting providers (Case Management Group); and (3) the same as the Case Management group plus a computer-based patient-education program before discharge specifically designed for use with subjects with limited health literacy using a embodied conversational agent and simple touch screen options and a telephone based post-discharge computerized health education and monitoring intervention (Case Management PLUS group). Outcome Measures: The primary outcome is 90-day hospital readmission. Process outcomes are the comprehensiveness of the discharge provided, adherence to disease specific up-to-date guidelines; emergency department and PCP visits, health status, and costs in each experimental group. We will evaluate the intervention in a stratified analysis to examine the effect of the intervention by literacy status.