Patient-Centered Care Transitions in Heart Failure (PACT-HF): A pragmatic multi-center cluster randomized trial
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.
Stepped wedge cluster randomized control trial
Primary outcomes are:
Secondary outcomes are patient-reported Discharge Preparedness, Care Transitions Quality, Health Related Quality of Life, and Quality Adjusted Life Years.
Harriette Van Spall