Comparing Two Acute Care Transition Programs for Older Adults and Their Family Caregivers (NCT07661355) | Clinical Trial Compass
Not Yet RecruitingNot Applicable
Comparing Two Acute Care Transition Programs for Older Adults and Their Family Caregivers
United States2,560 participantsStarted 2026-07
Plain-language summary
This study investigates better ways to help people after they leave the hospital and how to involve their families in this process. The main goal is to see if adding family support to a patient-centered hospital-to-home intervention helps patients stay safely at home, spend fewer days back in the emergency room or going back into the hospital. The study team also wants to see if the family-centered approach helps improve the patient's ability to do everyday activities without feeling overwhelmed. Two approaches are being compared: one focuses just on the patient, and the other includes special strategies to better support families involved too. Family will be involved in assessing what the patient and family needs. The family-focused approach not only emphasizes the experience, health, and safety of the patient but also the experience of the family member caring for the older adult. The study also involves families in education and provides families skills-building experiences that can help with caregiving stress, problem-solving, and communicating with the healthcare team. The approach will help the family member prepare for their loved one's transition home and provide coaching with the goal of reducing the mental, physical and financial burden of providing care at home. To spread the intervention across many states, the study team will be using telephone calls, video calls, and other technologies as families prefer.
Who can participate
Age range
18 Years
Sex
ALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Patient Inclusion Criteria:
* 65 and older
* English and Spanish speaking
* Preadmission location: community dwelling
* Distance from Hospital: Local and Distant (rural) included
* Cognitive impairment, dementia allowed
* Technology Literacy: Flexible from high to low
* EPIC readmission risk score over 12
* Discharged home
Patient Exclusion Criteria:
* Admitted from skilled nursing facility
* Discharged to skilled nursing facility
* Left Against Medical Advice (AMA)
* Planned readmission
* Died during index admission
* Caregiver unwilling to participate
Caregiver Inclusion Criteria:
* Adults 18 and older
* English and Spanish speaking
* Providing tangible support to patient
* Distance from Hospital: Local and Distant (rural) included
* Only Mild Cognitive Impairment allowed
* Able to be trained in Video Visit Technology
* Available to support post-discharge
Caregiver Exclusion Criteria:
• Has a greater than a mild cognitive impairment (≤ 22 on MCA)
Questions worth asking your doctor
Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.
1Based on my diagnosis and history, is this trial worth exploring for me — or is there a standard treatment we should try first?
2What does this trial's phase tell us about how much is already known about its safety and benefit?
3What would taking part actually involve for me — visits, tests, time, and travel?
4What are the known and possible risks or side effects I should weigh, and how would they be monitored?
5If this trial isn't the right fit, what other options or trials would you suggest I look into?
Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.
Questions for the trial coordinator
The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.
1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?
A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.