Skilled Nursing Facility At Home Trial

Purpose

Skilled Nursing Facility at Home is a multicenter randomized control trial that aims to evaluate a home-based model of providing post-acute care (PAC). We will enroll 650 hospitalized patients who require rehabilitation and/or skilled-nursing support upon discharge and randomly assign them to an intervention (home-based PAC) or control arm (facility-based PAC). Our design includes two different health systems in Massachusetts: Baystate Health and UMass Memorial Health. We will perform 1:1 randomization between the intervention and control arm using a permuted block design, with stratification by clinical site and payor group. The primary outcome of the trial will be the difference in hospital readmission and mortality rates from the time of enrollment to 30 days after enrollment. Secondary clinical, functional, and cost outcomes include length of stay in PAC, difference in health-related quality of life (HRQoL), and healthcare cost and utilization.

Conditions

  • Skilled Nursing Facility
  • Rehabilitation
  • Home Based Care

Eligibility

Eligible Ages
Over 18 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Age 18 or older - Admitted to an inpatient unit OR receiving home health and requiring an escalation to skilled-nursing facility care - Require post-acute care in a skilled nursing facility based on the clinical inpatient team's assessment (or, if the participant is coming from home, based on the home health team's assessment) - Pass the home readiness assessment - Reside within Greater Worcester or Greater Springfield

Exclusion Criteria

  • Inability to return to a home residence where care can be provided - Inability for patient or their proxy to provide informed consent for the study - Requires long-term care - Requires palliative or hospice care - On active chemotherapy - Post-transplant surgery - Requires hemodialysis - Requires radiation therapy - Requires two-person assist or mechanical lift - Expresses unwillingness to be randomized to SNF OR SNF at Home care - Considered clinically inappropriate by SNF at Home clinical team

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Health Services Research
Masking
Single (Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
No Intervention
Facility-based 		Facility based post acute care at a skilled nursing facility, as is the standard care model.
Active Comparator
Home-based 		Home-based Post-Acute Care
  • Other: Sub-Acute Rehab at Home
    Patients randomized to the intervention group will receive skilled nursing and rehabilitative care at home upon discharge from the hospital, or when eligible for skilled-nursing facility care when requiring a step up in services at home. Home care will be delivered and overseen by a multidisciplinary clinical team, which will develop individualized care plans based on diagnosis, specific rehabilitation objectives, and broader goals of care.
    Other names:
    • SNF at Home

Recruiting Locations

Baystate Medical Center
Springfield, Massachusetts 01199
Contact:
Peter Lindenauer, MD

UMass Memorial Medical Center
Worcester, Massachusetts 02446
Contact:
Apurv Soni, MD, PhD

More Details

Status
Recruiting
Sponsor
University of Massachusetts, Worcester

Study Contact

Study Team
508-523-1284
homerehab@umassmed.edu