title: Discharge information and support for veterans Receiving Outpatient Care in the Emergency Department: study design and methods.
abstract: BACKGROUND
  An explicit goal of Patient Aligned Care Teams (PACTs) within the Veterans Health Administration is to promote continuity of care in primary care clinics and thereby reduce Emergency Department (ED) utilization; however, there has been little research to guide PACTs on how to accomplish this.
  
  
  OBJECTIVE
  The overall goal of this study is to examine the impact of a primary care-based nurse telephone support program [DISPO ED] on Veterans treated and released from the ED who are at high risk for repeat visits.
  
  
  METHODS
  This study is a two group randomized, controlled trial to evaluate DISPO ED for Veterans treated and released from the ED who are at high risk for repeat visits. We define high risk as those who have had an ED visit or hospitalization during the 6 month period before the index ED visit and have ≥2 chronic conditions. Veterans are randomized to nurse telephone support or usual care. The primary outcome is repeat ED use within 30 days; secondary outcomes are patient satisfaction with care and total costs.
  
  
  CONCLUSIONS
  The results of this randomized, controlled trial with an Effectiveness-Implementation Type I Hybrid design will be directly relevant to the care of more than 500,000 high risk patients seen in Veterans' Affairs Medical Center (VAMC) EDs annually. Results will also be informative to health systems outside VA aiming to reduce ED use through accountable care organizations.
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA; Center for the Study of Human Aging and Development, Duke University, Durham, NC, USA. Electronic address: Susan.Hastings@va.gov.
authors.forename: Susan Nicole
authors.initials: SN
authors.lastname: Hastings
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Betts
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA; Center for the Study of Human Aging and Development, Duke University, Durham, NC, USA.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Schmader
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Courtney Harold
authors.initials: CH
authors.lastname: Van Houtven
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA; Center for the Study of Human Aging and Development, Duke University, Durham, NC, USA; Duke University School of Nursing, Durham, NC, USA.
authors.forename: Cristina C
authors.initials: CC
authors.lastname: Hendrix
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stechuchak
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Madeline
authors.initials: M
authors.lastname: Weiner
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Katina
authors.initials: K
authors.lastname: Morris
authors.affiliation: Ambulatory Care Service, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Kessler
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
mesh_terms: D000553:Ambulatory Care; D002908:Chronic Disease; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge; D017060:Patient Satisfaction; D012107:Research Design; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: Emergency Department; Nurse intervention; Randomized clinical trial; Telephone support; Veterans health