THRIVE Intervention for Transition Care
What You Need to Know Before You Apply
What is the purpose of this trial?
This trial tests a new method to assist Medicaid patients after hospital discharge. It ensures they receive proper home care and avoid returning to the hospital or emergency room shortly after discharge. The trial compares two groups: one receives special support and care coordination (THRIVE Intervention) for 30 days, while the other receives standard care without additional help. It suits Pennsylvania residents with Medicaid who were recently hospitalized and agree to home care services. As an unphased trial, this study provides a unique opportunity to enhance post-hospital care for Medicaid patients.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What prior data suggests that the THRIVE Intervention is safe for post-discharge care?
Research has shown that the THRIVE program is generally safe for patients. Studies have found that participants receiving THRIVE support had fewer hospital and emergency room visits, indicating the program is well-tolerated. These studies reported no serious side effects. Instead, patients benefited from the extra care and attention after hospital discharge. The THRIVE program focuses on helping people manage their care at home, an approach that has been shown to help maintain health after leaving the hospital. The program primarily involves regular check-ins and coordination with healthcare providers, emphasizing improved support rather than new medications, which is typically safe.12345
Why are researchers excited about this trial?
Researchers are excited about the THRIVE Intervention because it offers a new approach to managing patient care after hospital discharge. Unlike the usual care, which often leaves patients to navigate their recovery alone, THRIVE provides intensive case management and care coordination for a month. This proactive support aims to reduce readmissions and improve recovery outcomes by ensuring that patients have the resources and guidance they need during the critical transition period from hospital to home.
What evidence suggests that the THRIVE Intervention is effective for improving post-discharge outcomes?
Research has shown that programs like the THRIVE Intervention, which participants in this trial may receive, can aid recovery after hospital discharge. Studies have found that these programs can reduce the likelihood of hospital readmission and enhance health post-discharge. For instance, patients receiving this care often report a better quality of life and fewer health issues. By coordinating care and providing follow-up, as seen in the THRIVE model, both social and health needs are addressed, leading to greater patient satisfaction. Although the strength of the evidence varies, these programs generally help patients transition from hospital to home.15678
Who Is on the Research Team?
Margo B Brooks Carthon, PhD RN
Principal Investigator
University of Pennsylvania
Are You a Good Fit for This Trial?
This trial is for adults with Medicaid insurance in Pennsylvania who have been hospitalized and agree to home care. It's not for anyone under 18. The study looks at how well they do after leaving the hospital when they get extra support.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Training
Case managers are trained on the THRIVE clinical pathway
Intervention
Participants receive intensive post-discharge case management and care coordination
Follow-up
Participants are monitored for readmissions, ED visits, and primary care or specialist visits
What Are the Treatments Tested in This Trial?
Interventions
- THRIVE Intervention
Trial Overview
The THRIVE intervention is being tested, which includes a referral to home care services within 48 hours of discharge, oversight by a physician or provider for 30 days, and weekly case conferences to address health and social needs.
How Is the Trial Designed?
2
Treatment groups
Experimental Treatment
Active Control
1 month intensive post discharge case management and care coordination.
Discharge to home without intensive post acute case management or care coordination.
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Pennsylvania
Lead Sponsor
Rita & Alex Hillman Foundation
Collaborator
Published Research Related to This Trial
Citations
Pre-Implementation Strategies to Support Adaptation of Thrive
The goal of this paper is to describe the pre-implementation processes used by our team to adapt the Thrive care model to meet the transitional ...
Integrated Care Components in Transitional Care Models ...
Service outcomes are more frequently reported compared to patient and provider outcomes, as out of the ten most frequent reported outcomes, ...
Effectiveness of transitional care interventions in patients with ...
Transitional care interventions can improve quality of life and symptoms, although based on low or very low certainty of evidence.
Transitional Care Interventions in Improving Patient and ...
This study aims to map existing evidence on effectiveness of transitional care interventions in improving post-discharge outcomes.
Effectiveness of Transitional Interventions in Improving ...
We aimed to assess the effectiveness of transitional interventions with predischarge and postdischarge components in reducing readmissions and improving health ...
Our Impact
Our published study in BMJ Open Quality found that participants enrolled in Thrive experienced lower rates of rehospitalizations and Emergency Department. View ...
Transitional Care Support for Medicaid-Insured Patients ...
This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric ...
Postpartum Discharge Transition | AIM
The Postpartum Discharge Transition Patient Safety Bundle was revised in 2021 to incorporate respectful care concepts and data collection tools.
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