Reducing Length of Stay for Veterans Hospitalized With Pneumonia
Primary Purpose
Pneumonia
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
reminder
Sponsored by
About this trial
This is an interventional health services research trial for Pneumonia
Eligibility Criteria
Inclusion Criteria:
- Patient hospitalized with outpatient-acquired pneumonia at South Texas Veterans Health Care System during study period.
Exclusion Criteria:
none
Sites / Locations
- South Texas Health Care System, San Antonio, TX
Arms of the Study
Arm 1
Arm 2
Arm Type
No Intervention
Experimental
Arm Label
Arm 1
Arm 2
Arm Description
pre-implementation of computer based intervention
post-implementation of computer based length of stay clinical reminder
Outcomes
Primary Outcome Measures
Length of Hospital Stay
Secondary Outcome Measures
Time to Change to Oral Antibiotics
Full Information
NCT ID
NCT01068548
First Posted
February 8, 2010
Last Updated
January 7, 2019
Sponsor
VA Office of Research and Development
1. Study Identification
Unique Protocol Identification Number
NCT01068548
Brief Title
Reducing Length of Stay for Veterans Hospitalized With Pneumonia
Official Title
Reducing Length of Stay for Veterans Hospitalized With Pneumonia
Study Type
Interventional
2. Study Status
Record Verification Date
January 2019
Overall Recruitment Status
Completed
Study Start Date
February 2011 (undefined)
Primary Completion Date
September 2011 (Actual)
Study Completion Date
November 2011 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
VA Office of Research and Development
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This is a pilot study to implement a computer based intervention to safely reduce length of hospital stay and time to conversion to oral antibiotics for patients with pneumonia.
Detailed Description
Pneumonia is the 3rd leading medical discharge diagnosis in the VA, and although significant attention has been focused improving pneumonia process of care measures less attention has been paid to resource use, specifically length of hospital stay (LOS). Based on our preliminary analyses LOS is considerably higher in the VA versus other non-federal hospitals. Major causes of this increased length of stay are delayed conversion from intravenous (IV) to oral therapy upon reaching clinical stability, and not discharging on the same day as the conversion to oral antibiotics. Therefore additional interventions are needed to decrease the LOS for veterans hospitalized with pneumonia in the VA system.
The long-term goal of this research is to develop sustainable approaches to reduce LOS and thereby improve efficiency of care in veterans admitted with pneumonia to VA Medical Centers through the implementation of computerized clinical stability reminders. Although prior research, including our own, has demonstrated moderate effectiveness of resource intense methods to implement this criteria (e.g., utilization management nurses) new, more effective and less resource intense, strategies are needed to accomplish this long-term goal. The design of the computerized clinical stability reminder, the likely range in magnitude of response to implementation of the intervention, logistics of data collection, data management, and development of study instruments are needed prior to commencement of a more definitive, multi-center study. Hence, we are seeking funding to conduct the necessary pilot work needed to successfully design and implement a large multi-center randomized intervention study to reduce LOS for veterans with pneumonia.
Our objectives include: 1) Develop and perform a local pilot implementation of an inpatient clinical reminder within Computerized Patient Record System to identify when veterans hospitalized with pneumonia are clinically stable and ready for conversion form IV to oral antibiotic therapy and hospital discharge. 2) Test measures of the constructs of the Theory of Planned Behavior (TPB) in VA medicine ward physicians and determine if they correlate with intention and discharge behavior. 3) Establish a collaborative of VA Medical Centers for the purpose of developing a larger scale implementation study to use evidence-based criteria to reduce LOS for patients hospitalized with pneumonia. 4) Prepare a VA HSR&D IIR grant proposal for a cluster randomized controlled trial of a clinical reminder intervention to reduce length of hospital stay among veterans hospitalized with pneumonia.
The proposed pilot study will develop and implement a computerized-based inpatient clinical reminder to assist physicians with appropriate conversion from IV to oral antibiotics and discharge on the same day for veterans hospitalized with pneumonia. In addition to creating and implementing the clinical reminder at single tertiary care VA teaching hospital, we will examine physician attitudes and potential barriers/facilitators to the introduction of inpatient clinical reminders using the theoretical model of TPB. We will also assemble a cohort of VA medical centers with investigators and chiefs of medical staff willing to participate in a multi-center randomized control trial of this intervention. The results from this pilot study will be used to plan a larger, more definitive multi-center trial of this inpatient clinical reminder with the goal of significantly reducing LOS for veterans hospitalized with pneumonia in the VA health care system.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pneumonia
7. Study Design
Primary Purpose
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
129 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Arm 1
Arm Type
No Intervention
Arm Description
pre-implementation of computer based intervention
Arm Title
Arm 2
Arm Type
Experimental
Arm Description
post-implementation of computer based length of stay clinical reminder
Intervention Type
Other
Intervention Name(s)
reminder
Intervention Description
computer based reminder to change patients from IV to oral antibiotics based on evidence based clinical practice guidelines
Primary Outcome Measure Information:
Title
Length of Hospital Stay
Time Frame
1 month
Secondary Outcome Measure Information:
Title
Time to Change to Oral Antibiotics
Time Frame
1 month
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patient hospitalized with outpatient-acquired pneumonia at South Texas Veterans Health Care System during study period.
Exclusion Criteria:
none
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eric Michael Mortensen, MD MSc BA
Organizational Affiliation
South Texas Health Care System, San Antonio, TX
Official's Role
Principal Investigator
Facility Information:
Facility Name
South Texas Health Care System, San Antonio, TX
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
12. IPD Sharing Statement
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Reducing Length of Stay for Veterans Hospitalized With Pneumonia
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