Digital Communication Tool for Post-Hospitalization Care in Older Adults
(DB Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
Older adults who live with multiple chronic conditions are more likely to experience frequent admissions and discharges from hospital. These transitions are often challenging and leave people at risk of readmission. Appropriate, timely and person-centred communication across all health care providers involved in transitions (in and out of hospital) as well as with patients and their families is critical to ensure a smooth and effective transition process. Digital health technologies can play an important role in improving person-centred communication across clinical settings and clinicians. This project will develop and test a Digital Bridge by connecting communication technologies already in use in hospital and primary care/community settings to improve communication between providers in hospital and in primary care, patients and family caregivers from admission to 6 months post-discharge. The investigators will engage with all the technology users to co-design the Digital Bridge, ensuring that how the investigators connect the existing technologies and adopt them into practice will meet the needs of providers, patients and their caregivers. Next hospital partners will adopt the technology into general medicine and rehabilitation services in hospital systems in Toronto (Sinai Health System) and Mississauga (Trillium Health Partners). The investigators will evaluate the Digital Bridge through a pre-post pragmatic trial, assessing impact on patient experience (quality of transition), patient outcomes (quality of life), transition processes (provider communication and teamwork), and system costs (economic evaluation). This project adopts an implementation science lens, allowing the investigators to collect qualitative data on enablers and barriers to adopting the Digital Bridge to help inform development of a scale and spread strategy.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It seems focused on improving communication during hospital transitions, so it's unlikely to require changes to your medication regimen.
Is the Digital Communication Tool for Post-Hospitalization Care in Older Adults safe for use?
How is the Digital Communication Tool for Post-Hospitalization Care in Older Adults different from other treatments?
What data supports the effectiveness of the treatment Digital Bridge, Digital Bridge to Home, Care Connector, ePRO tool for post-hospitalization care in older adults?
Who Is on the Research Team?
Carolyn Steele Gray, PhD
Principal Investigator
Sinai Health System
Terence Tang, MD
Principal Investigator
Trillium Health
Michelle Nelson, PhD
Principal Investigator
Sinai Health System
Are You a Good Fit for This Trial?
This trial is for older adults aged 60 and over with complex care needs, defined as having three or more chronic conditions. Participants must speak and read English, be able to respond to surveys, have family or caregivers available if needed, and plan to go home after hospital discharge.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Intervention Development
Co-design of the Digital Bridge with technology users to ensure it meets the needs of providers, patients, and caregivers
Implementation
Adoption of the Digital Bridge technology into general medicine and rehabilitation services in hospital systems
Follow-up
Participants are monitored for transition quality, quality of life, and goal attainment post-discharge
What Are the Treatments Tested in This Trial?
Interventions
- Digital Bridge
Find a Clinic Near You
Who Is Running the Clinical Trial?
Mount Sinai Hospital, Canada
Lead Sponsor
MOUNT SINAI HOSPITAL
Collaborator
Trillium Health Partners
Collaborator
Canadian Institutes of Health Research (CIHR)
Collaborator