Care Transitions App for Multiple Chronic Conditions
What You Need to Know Before You Apply
What is the purpose of this trial?
This trial tests a Care Transitions App designed to assist individuals with multiple long-term health conditions, such as diabetes, heart failure, and kidney disease, in managing their care after hospital discharge. The app includes tools to reduce falls, provides a post-hospital care plan, and helps track symptoms and recovery goals. Participants will either use this app or follow their usual care routine to determine which is more effective. Suitable participants speak English, have been hospitalized, and live with at least two chronic conditions, including heart failure, diabetes, or kidney disease. As an unphased trial, this study offers a unique opportunity to contribute to innovative care solutions and improve post-hospitalization management for chronic conditions.
Do I need to stop my current medications for the trial?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What prior data suggests that the Care Transitions App is safe for patients with multiple chronic conditions?
Research has shown that the Care Transitions App assists patients after hospital discharge. The app aims to reduce falls, medication errors, and hospital readmissions, common post-discharge issues. Although studies lack specific safety details about the app, digital tools like this are generally designed to enhance patient safety and care, not to cause harm. The trial's "Not Applicable" phase indicates that the app is neither a drug nor a device that interacts directly with the body. Instead, it serves as a supportive tool, minimizing safety concerns.12345
Why are researchers excited about this trial?
Researchers are excited about the Care Transitions App because it offers a fresh approach to managing multiple chronic conditions after hospital discharge. Unlike the usual care, which often involves standard follow-up visits and phone calls, this app provides patients with continuous digital support and guidance during their transition back home. The app's ability to deliver personalized care plans and real-time communication with healthcare providers has the potential to significantly improve patient outcomes and reduce hospital readmissions. This innovative approach leverages technology to enhance patient engagement and self-management, making it a game-changer in the care transition landscape.
What evidence suggests that the Care Transitions App is effective for managing multiple chronic conditions?
Research has shown that digital health tools can assist people with multiple long-term health issues during the transition from hospital care to home care. In this trial, participants will either use the Care Transitions App or receive usual care. Studies have found that using a Care Transitions App can lead to better outcomes, such as fewer hospital visits within 30 days after discharge. The app provides patients with a personalized care plan, including medication schedules, follow-up appointments, and warning signs to monitor. By helping patients manage their health more effectively after leaving the hospital, the app aims to support their recovery and overall well-being. These early findings suggest that the app can significantly aid in managing chronic conditions effectively.12356
Who Is on the Research Team?
Lipika Samal, MD, MPH
Principal Investigator
Brigham and Women's Hospital
Are You a Good Fit for This Trial?
This trial is for adults aged 55+ with multiple chronic conditions such as heart failure, chronic kidney disease, and type 2 diabetes. They must be fluent in English (or have a proxy who is), discharging to home or similar care settings, and have a primary care physician at one of the specified locations.Inclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants use the Care Transitions App to support care transition after hospital discharge
Follow-up
Participants are monitored for post-discharge adverse events and readmission rates
What Are the Treatments Tested in This Trial?
Interventions
- Care Transitions App
Find a Clinic Near You
Who Is Running the Clinical Trial?
Brigham and Women's Hospital
Lead Sponsor
Agency for Healthcare Research and Quality (AHRQ)
Collaborator