Clinical Information System Impact on Hospitalized Patients With Chronic Disease
Trial statusNot yet recruiting
Trial phaseNot listed
Trial typeObservational
Biological sexAll
Age18+
SponsorUniversity of Calgary
About this trial
This is a retrospective, observational study using routinely collected information collected by Alberta Health Services. The study will identify patients with chronic disease, defined by one or more of the following conditions; diabetes mellitus, heart failure, coronary artery disease, chronic kidney disease, or chronic lung disease. Adult residents of Alberta with a chronic disease of interest present upon hospital admission and who survive to hospital discharge will be included in the study cohort. The primary outcome will be the composite of hospital readmission or death within 30 days of discharge. Secondary outcomes will include components of the composite, length of stay, patient experiences related to their hospital to home transition of care, and processes of care. Multi-level interrupted time series analysis will be used to compare outcomes before versus after implementation of the Connect Care CIS.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Adults aged 18 years or older at the time of hospital admission.
Residents of Alberta eligible to receive acute-care services in AHS facilities.
Hospitalized for any cause during the study period (5 years pre-implementation and 2 years post-implementation of the CIS).
Meet the validated case definition for one or more of the five key NCDs (diabetes mellitus, chronic kidney disease, coronary artery disease, heart failure, or chronic lung disease) based on ICD codes, laboratory measures, or pharmacy records during standardized lookback periods (up to 5 years for diagnoses; up to 1 year for labs/pharmacy).
Disqualifiers
Individuals younger than 18 years at the time of hospital admission.
Non-residents of Alberta or individuals not eligible for care within AHS facilities.
Hospitalizations that end in death (excluded from analyses of the primary outcome and patient experience measures).
Patients without evidence of any of the five key NCDs during the lookback period or at the index hospital admission.
Trial population
The study population consists of adult Alberta residents receiving acute-care services in Alberta Health Services (AHS) facilities who have one or more of five key noncommunicable diseases: diabetes mellitus, chronic kidney disease, coronary artery disease, heart failure, or chronic lung disease. Participants are identified from routinely collected administrative, laboratory, and pharmacy datasets, with hospital admissions included regardless of most responsible diagnosis. The population is broadly representative of adults with chronic conditions experiencing transitions from hospital to home across the province. Patient experience survey data are available for a random 10% sample of eligible discharges.
Trial design
Design model
Other
Time perspective
Other
Treatments tested in this trial
Clinical Information System (CIS) / Connect Care Implementation
Other interventionThe intervention (exposure) is the implementation of the Connect Care Clinical Information System (CIS) across Alberta Health Services (AHS) acute-care facilities. Connect Care integrates comprehensive electronic health records, clinician communication tools, pharmacy dispensing data, laboratory and diagnostic imaging results, standardized medication reconciliation, and electronic discharge summaries. It supports coordination across hospital, specialty, and primary care settings and includes a patient-facing portal allowing access to personal health information. The CIS rollout occurred at multiple sites with staggered launch dates and represents one of the largest Epic deployments.
Treatment groups
124,240 Participants
are divided into 1 treatment groupGroup A: Adults with Key NCDs Receiving Acute Care in AHS1 intervention
Trial outcomes
Primary outcomes
1
All-cause unplanned hospital readmission or death within 30 days after hospital discharge
This primary outcome captures whether a patient experiences either (1) the unplanned hospital readmission for any cause or (2) death from any cause within 30 days following discharge from an acute-care hospitalization. The outcome is restricted to patients who survived to hospital discharge. Analyses will also be stratified by the presence of each of the five key NCDs (diabetes, CKD, CAD, heart failure, chronic lung disease) and by multimorbidity (two or more of the NCDs).
Time frame
Within 30 days after hospital dischargeSecondary outcomes
1
Acute care admission frequency
Number of acute-care hospital admissions occurring during monthly intervals.
Time frame
Monthly intervals across the 7-year follow-up (5 years pre-implementation, 2 years post-implementation2
Length of stay in hospital
Duration of index hospitalization in days, excluding days coded as alternate level of care (occupying a hospital bed but no longer needing acute care while waiting for a transfer to a more suitable setting like long-term care, rehab, or home support), measured from admission to discharge, including multi-facility episodes.
Time frame
From hospital admission date to date of discharge or switch to alternate level of care, up to a maximum of 30 days3
30-day all-cause mortality
Death from any cause within 30 days after hospital discharge, assessed independently from readmission.
Time frame
Within 30 days after each discharge.4
30-day all-cause readmission
Any acute-care readmission occurring within 30 days after discharge, analyzed separately from mortality.
Time frame
Within 30 days after each discharge.Other outcomes
1
Interrupted time series (ITS) slope and level changes
Estimated changes in outcome level and trend immediately following CIS implementation and over time, using monthly segmented regression across staggered site launch dates.
Time frame
Monthly intervals for 5 years pre-implementation and 2 years post-implementation.Sponsors and contacts
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Source ClinicalTrials.gov
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