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Proud to have led this #clusterRCT, presented @ESCCardio's #LBCT session & published today in @JAMA_current. Among 2495 adults (50% women) hospitalized for #HF, a transitional care model implemented in our publiclyfunded system did not ⬇️time to comp readmission/ED visit/death.
There was a significant improvement in the patient-reported outcomes of #discharge-preparedness, #qualityofcaretransition, and #QOL. However, there was no improvement in #QALY. The #PROs were not adjusted for multiplicity, but we will do post-hoc exploratory analysis.
The study was #pragmatic, designed to assess effectiveness rather than efficacy. In contrast to a parallel #clusterRCT, a #steppedwedge cluster RCT - used in this study - is one in which all clusters cross over in a randomized sequence from control to intervention. @lamelaspablo
#Steppedwedge #clusterRCTs are ideal when there is minimal risk to patients, when all clusters wish to receive intervention, & when staged approach is preferred for implementation. Effect is determined via inter and intra cluster comparisons. Need measures to prevent contaminat'n
This #RCT was unique in obtaining clinical outcomes from administrative databases in which patients were embedded, so that did not have to attend follow-up appointments. Outcomes were selected in collaboration with decision-makers as well as patients. @denniskomd @fengxie_mac
A sincere thanks to Stuart Connolly, @HamHealthSci's Research Admin, @PHRIresearch, and @MacDeptMed for trial support, & to our collaborating investigators, research institutes, hospitals, and community agencies across the province. #7years of work! @Chief_Innovator #teamwork
This work is dedicated to my dad, whose preventable cardiac death just after I began cardiology training taught me painful lessons about the cracks in our health care system.
