Comparing Two Acute Care Transition Programs for Older Adults and Their Family Caregivers

This study is looking for better ways to help older adults go home from the hospital and stay healthy, especially with support from their families. It compares two approaches: one that focuses on the patient's needs (Patient-Centered Intervention) and another that also includes special support for family caregivers (Family Caregiver Enhanced Intervention). The goal is to see if adding family support helps patients avoid returning to the hospital or emergency room, and if it helps them with daily activities without feeling overwhelmed. You might be able to join if you are 65 or older, speak English or Spanish, live at home, and are being discharged from the hospital. The study is currently unclear on its recruitment status and plans to enroll 2560 people.

Study design
This interventional study plans to enroll 2560 participants. It compares two different care transition programs.
What's involved
Not specified in the trial record.
Compensation
Not stated in the trial record.
Follow-up
The main goal is measured at Day 60, looking at how many days you are not in the hospital.

AI-generated from the public study record. Only the study team can confirm whether you're eligible — confirm details with them before making decisions.

NCT07661355

Comparing Two Acute Care Transition Programs for Older Adults and Their Family Caregivers

Recruiting
NAAges 18+InterventionalSupportive care
Wake Forest University Health Sciences
~2,560 participants
Updated 2026-07-31 on ClinicalTrials.gov
What's tested:Patient-Centered ProgramFamily Caregiver Enhanced Program

At a glance

Recruiting sites
4 of 4 listed sites are recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Hospital-Free Days
Measured over Day 60
Care Transition

NCT07661355

Where you'd take part

This study runs at 4 sites. They're the same protocol — you choose where, and that choice sets who your contact draft is addressed to.

  • Atrium Health Wake Forest Baptist Medical Center

    Winston-Salem, North Carolinastudy coordinator listed

    Recruiting

  • Atrium Health Wake Forest Baptist Wilkes Medical Center

    North Wilkesboro, North Carolinastudy coordinator listed

    Recruiting

  • Davie Medical Center

    Bermuda Run, North Carolinastudy coordinator listed

    Recruiting

  • High Point Medical Center

    High Point, North Carolinastudy coordinator listed

    Recruiting

Sites open and close at different times, so the status above is per site — it can differ from the study's overall status.

  • Thomas Houston, MD · PRINCIPAL_INVESTIGATOR · Wake Forest University Health Sciences

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Eligibility criteria

Inclusion

65 and older
English and Spanish speaking
Preadmission location: community dwelling
Distance from Hospital: Local and Distant (rural) included
Cognitive impairment, dementia allowed
Technology Literacy: Flexible from high to low
EPIC readmission risk score over 12
Discharged home
Adults 18 and older
English and Spanish speaking
Providing tangible support to patient
Distance from Hospital: Local and Distant (rural) included
Only Mild Cognitive Impairment allowed
Able to be trained in Video Visit Technology
Available to support post-discharge

Exclusion

Admitted from skilled nursing facility
Discharged to skilled nursing facility
Left Against Medical Advice (AMA)
Planned readmission
Died during index admission
Caregiver unwilling to participate
  • Hospital-Free DaysDay 60

    The count of days alive and outside acute care hospitals from discharge to day 60. It will be calculated using EHR and Medicare claims data to objectively capture hospital free days elements (i.e.: mortality days, inpatient days, observation stays, and ED visits).