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PACT-HF

Official Title

Patient-Centered Care Transitions in Heart Failure (PACT-HF): A pragmatic multi-center cluster randomized trial

Status

Completed

Overview

We used a pragmatic stepped wedge cluster randomized design to introduce PACT-HF across 10 large hospitals in our publicly funded health care system.

The goal was for all patients hospitalized with HF to receive self-care education, multidisciplinary care services, and early follow-up with their primary health care providers; and for high-risk patients to receive nurse-led home visits and outpatient care in Heart Function clinics following hospital discharge.

We redesigned workflow to integrate health care services across institutions and regional networks that typically work independently of each other.

We obtained clinical outcomes via linkages to provincial administrative databases, analyzing them using shared frailty survival models adjusted for the stepped wedge design.

We analyzed secondary outcomes using hierarchical models adjusted for the stepped wedge design. We applied the Intention-to-treat principle for all analyses.

Study Design

Stepped wedge cluster randomized control trial

Primary Endpoint

Primary outcomes are:

  1. Time to 3-month composite all-cause readmissions, emergency department (ED) visits, and death.
  2. 30-day composite all-cause readmissions and ED visits.

Secondary outcomes are patient-reported Discharge Preparedness, Care Transitions Quality, Health Related Quality of Life, and Quality Adjusted Life Years.

Number of Patients

4500

Number of Sites

10

Number of Countries

1

Study Period

2014–2018

Principal Investigator

Harriette Van Spall

Program Manager

Kimberly Begley

Research Coordinator

Kim Simek