Comparative Effectiveness of Readmission Reduction Interventions for Individuals with Sepsis or Pneumonia (ACCOMPLISH Study)

This study compares five ways to remotely monitor the health and wellbeing of patients with multiple chronic conditions once they return home from the hospital after treatment for sepsis or lower respiratory tract infection (LRTI).

Funded by:

Patient-Centered Outcomes Research Institute (PCORI®)

Funding Amount:

$4,416,351

Project Duration:

August 3, 2020 - July 31, 2026

Project Collaborators:

Wolff Center at UPMC, UPMC Community and Ambulatory Services, UPMC Clinical Analytics, University of Pittsburgh Department of Critical Care Medicine

Research Location:

This study takes place in 20 hospitals throughout western and west-central Pennsylvania.

Background

Having multiple chronic, or long-term, health problems can make it more likely that patients who’ve had an infection, such as pneumonia, return to the hospital after a hospital stay. Monitoring patients' health at home after they leave the hospital may keep them from having to return. Many hospitals monitor patients with a telephone call. A nurse calls patients two days after they leave the hospital to answer questions and check on medicines and follow-up care. But for patients with multiple chronic conditions, a single telephone call may not be enough.
In this study, the research team is comparing different smart phone-based approaches to monitor patients at home for three months after hospitalization. The team wants to learn which approaches keep patients from returning to the hospital.

See our clinicaltrials.gov and PCORI® descriptions for more details.

Health Care Challenge

Nationally, hospital readmissions after sepsis and pneumonia are more common and more costly than readmissions due to heart failure, chronic obstructive pulmonary disease (COPD), or myocardial infarction. Research suggests that if identified early enough, the cause of many of these readmissions could be treated on an outpatient basis potentially allowing patients to stay out of the hospital and spend more time at home.

Goals

  • Maximize UPMC Health Plan member days spent at home by identifying the remote-patient monitoring (RPM) strategy that best identifies and treats post-discharge health issues before they cause a hospital readmission among patients with sepsis and lower respiratory tract infections.
  • Learn the facilitators, barriers, and contextual factors associated with RPM engagement, satisfaction, and effectiveness.

Implementation Approach

Population

UPMC Health Plan and traditional Medicare Fee-for-Service patients hospitalized with sepsis or lower respiratory tract infection (LRTI) and at medium- to high risk of readmission who own a phone or computer which they can use to participate in RPM.

Methodology

This randomized controlled trial uses an adaptive randomization approach in which, every three months, the study team determines which of the four RPM strategies is best helping patients stay out of the hospital and then gives future patients the highest probability of being enrolled in the best performing RPM strategy. The study will compare the usual post-hospital discharge phone call from a nurse with four different RPM strategies that vary based on the health questions asked of participants and the credentials of the health care response team.

Participants must have access to a smart phone or a computer to be eligible for the study.

  • Structured Telephone Support: A nurse will call the patient once within seven days after discharge to check in, help them understand their medicines, and make sure they get the care they need.
  • RPM Low: Questions focused on worsening infection.
  • RPM High: Questions focused on worsening infection and worsening underlying heart and lung conditions.
  • Standard Team: Remote Patient Monitoring (RPM) alerts are screened by a nurse-staffed call center. Nurses determine whether emergency care is needed. If not, nurses contact the patient and/or the patients’ PCP or specialist to coordinate care and ensure timely follow-up.
  • Enhanced Team: Remote Patient Monitoring (RPM) alerts are screened by a nurse-staffed call center. Nurses determine whether emergency care is needed. If not, the call center alerts a multidisciplinary care team that is led by a certified registered nurse practitioner (CRNP). CRNPs, who operate in a palliative care role, have prescribing authority and can modify care plans. In addition to reacting to RPM triggers, team members (e.g., CRNP, social workers, nurses) meet with the patient in-person or virtually in the week after discharge and at least twice more in the next 90 days, conduct assessments and a pharmacy review, develop care plans, and complete a POLST (physician orders for life-sustaining treatment) or an PA Advance Care Directive.

Participants were asked to complete two surveys for the project. One immediately after they are discharged home from the hospital and at 90 days. Participants reported on their physical function and quality of life during these surveys.

Both the intervention teams, participant PCPs, and participants completed qualitative interviews. Participants were asked to share about their satisfaction, value of the study, and if the study improved quality of life. The care team (intervention teams and PCPs) were invited to share about challenges and benefits to engaging and implementing the ACCOMPLISH Project.

The study design implementation is advised by patient-partners, a patient-partner study co-investigator, and an advisory board comprising health providers, patients, researchers, payers, policy makers, and community organizers/organizations.

Outcomes of Interest

The number of days patients spent at home during the 90 days after hospital discharge to home, and the effectiveness of each monitoring strategy considering additional patient factors such as comorbidities, living arrangements, age, gender, and socioeconomic status.

Research reported on this webpage was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Award (IHS-2019C1-16055). The views, statements, and opinions presented in this webpage are solely the responsibility of the author(s) and do not necessarily represent the views of the PCORI®. The Patient-Centered Outcomes Research Institute® (PCORI®) is an independent, nonprofit organization authorized by federal law. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continually seeking input from a broad range of stakeholders to guide its work.

Resources

ACCOMPLISH Study Poster 2022

Fliers