Emergency care provided at home instead of in a hospital
Emergency Care at Home: A Randomized Controlled Trial
This study is testing whether providing emergency medical care at home can be better for older adults and people with serious illnesses than going to the hospital.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 1500 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Brigham and Women's Hospital Academic / other |
| Locations | 1 site (Boston, Massachusetts) |
| Trial ID | NCT06299774 on ClinicalTrials.gov |
What this trial studies
This study evaluates the effectiveness of delivering emergency medical care at home compared to traditional emergency department visits. It focuses on populations that may be underserved by conventional emergency services, such as older adults and those with serious illnesses. The study employs a randomized controlled trial design to assess outcomes related to patient safety, satisfaction, and overall health. By addressing the challenges of emergency department crowding and potential harms associated with hospital visits, the trial aims to explore a more patient-centered approach to emergency care.
Who should consider this trial
Good fit: Ideal candidates include adults aged 18 and older who are patients of a Mass General Brigham primary care provider and reside within the designated geographic area.
Not a fit: Patients living in healthcare facilities or those with acute psychiatric concerns or high-risk features may not benefit from this study.
Why it matters
Potential benefit: If successful, this approach could enhance patient outcomes by reducing the risks associated with emergency department visits for vulnerable populations.
How similar studies have performed: While the concept of home-based emergency care is gaining attention, this specific approach is relatively novel and has not been extensively tested in prior studies.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Age \>= 18 years * Resides within Home Hospital geographic area * Lives in permanent housing (i.e., not in temporary housing such as a shelter) * Patient of a Mass General Brigham primary care provider * Primary care provider attests that their triage recommendation is the emergency department * Emergency care at home nurse triages the participant to the emergency department or urgent care * Patient attests that they intend to go to the emergency department Exclusion Criteria: * Insurance: workers compensation and motor vehicle accident * Lives in a healthcare facility (Skilled Nursing, Rehab, long term acute care) * Patient/caregiver cannot answer phone or door * Active substance use * Acute psychiatric concerns (e.g., suicidal ideation, even if passive) * Home safety concerns (e.g., intimate partner violence) * High-risk features: oHigh Risk Signs, if available: Heart rate \> 120 Systolic blood pressure \< 90 Shock Index (heart rate divided by systolic blood pressure) \> 1 Oxygen \< 93% on ambient air Increase in oxygen requirement new or \> 2 liters Respiratory rate \> 28 Diaphoresis oHigh Risk Symptoms: Active chest pain Severe work of breathing Syncope Hemoptysis Seizure Other concerning symptom per nurse triage * Requires inpatient-level care * Requires specialty consultation * Requires physical, occupational, or speech therapy * Requires blood transfusion * Requires internal physical exam maneuver (e.g. rectal exam, genitourinary exam) * Requires imaging that is not available at home * Requires monitoring that is not available at home * Troubleshooting wound vacs
Where this trial is running
Boston, Massachusetts
- Massachusetts General Hospital — Boston, Massachusetts, United States (Recruiting)
Study contacts
- Study coordinator: David Levine, MD, MPH, MA
- Email: dmlevine@bwh.harvard.edu
- Phone: 6177327063
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.