Improving TRansitions ANd OutcomeS for Heart FailurE Patients in Home Health CaRe (I-TRANSFER-HF)

Part of paid clinical trials in New York, New York.

Sponsor
Weill Medical College of Cornell University
Study ID
NCT06118983
Status
Recruiting
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Conditions

Eligibility Criteria

Sex
ALL
Age
18 Years - N/A
Healthy Volunteers
Accepted

Interventions

  • I-TRANSFER-HF — OTHER
    I-TRANSFER-HF is comprised of early and intensive HHC nurse visits and an outpatient visit within 7 days of discharge. Using a Hybrid Type 1, stepped wedge randomized trial design, we will test the effectiveness and implementation of I-TRANSFER-HF in partnership with 4 geographically diverse dyads of hospitals and HHC agencies ("hospital-HHC agency" dyads) across the US.

Study Details

This study is trying to improve the hospital-to-home transition for people with heart failure who receive home care services. The study will test an intervention called I-TRANSFER-HF, which differs from usual care by combining early home health nurse visits and outpatient medical appointments. The study is interested in two questions: 1. Is I-TRANSFER-HF better than usual care at preventing heart failure patients from returning to the hospital within 30 days? 2. Are there parts of I-TRANSFER-HF that are easy or hard to implement in the real world? The researchers will answer these questions by testing the intervention among pairs of hospitals and home health agencies across the country. During the study, the hospital-agency pairs will be asked to implement I-TRANSFER-HF. The researchers will then compare the results from before and after I-TRANSFER-HF was adopted. They will also interview people from these hospitals and agencies to see how I-TRANSFER-HF is being implemented under real-world conditions.

Key Dates

Start date
Jul 1, 2026
Status verified
Apr 2026
Primary completion
Jul 1, 2027
Completion
Jul 1, 2028

Study Design

Enrollment
1,094 participants (estimated)
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH

Arms

  • Experimental: I-TRANSFER-HF
    This is a 1-year long intervention period when I-TRANSFER-HF is in operation.
  • No Intervention: Standard of Care (usual care)
    This is a baseline period of usual care (UC) with no intervention.

Primary Outcome Measure

All-cause 30-day hospital readmission [ Time Frame: 30 days following post-Index HF Hospitalization ]

Central Contacts

Locations (2)

FacilityCityStateZIPSite coordinators
VNS Health Partners in CareNew YorkNew York10017
Kathy Bowles, PhD, RN,FAAN
[email protected]
Weill Cornell MedicineNew YorkNew York10021
Madeline R Sterling, MD, MPH, MS
[email protected]
646-962-5029
Madeline R Sterling, MD, MPH, MS (PRINCIPAL_INVESTIGATOR)

Find similar trials in New York, NY

By condition
Heart failure
By specialty
CardiologyHeart disease
By research site
VNS Health Partners in Care· New York, NYWeill Cornell Medicine· New York, NY

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