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Evaluating Interventions to Reduce Hospital Readmissions

This study at Michigan Medicine is looking at different ways to assign support services (called Transition of Care or TOC interventions) to patients after they leave the hospital. Researchers want to see if using a risk prediction score, either C-HARP TOC assignment or The LACE Index TOC assignment, can help reduce the number of times patients are readmitted to the hospital or pass away within 30 days of discharge. You might be able to join if you are 18 or older, receive primary care at Michigan Medicine, and your primary care doctor is in one of their General Medicine, Family Medicine, or Medical-Pediatrics departments. The study is currently unclear on its recruitment status, but plans to enroll about 5000 people.

Study design
This interventional study plans to enroll 5000 participants. It compares two different methods for assigning support services after hospital discharge.
What's involved
Not specified in the trial record.
Compensation
Not stated in the trial record.
Follow-up
The study will track whether you are readmitted to the hospital or pass away for 30 days after you leave 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.

NCT07690657

Evaluating Intervention Allocation Policies for Reducing Hospital Readmissions at Michigan Medicine

Not Yet Recruiting
NAAges 18+InterventionalPrevention
University of Michigan
~5,000 participants
Updated 2026-07-08 on ClinicalTrials.gov
What's tested:C-HARP TOC assignmentThe LACE Index TOC assignment

At a glance

Recruiting sites
0 of 1 listed site is recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
The number of 30-day all-cause unplanned readmission or death
Measured over 30 calendar days following the index discharge

Conditions

Transition of Care

Explore related trials

Hospital Readmission

Where it's being run

1 sites across 1 states
Michigan1

Study leadership

  • Jenna Wiens, PhD · STUDY_CHAIR · University of Michigan

Who to contact

Stephanie Shepard, PhD
[email protected]
734-647-1098
Email the study team

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Do you actually qualify for this trial?

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Eligibility criteria

Inclusion

Patient meets the primary care established rule at Michigan Medicine (MM), AND
Patient's primary care physician (PCP) Department is one of our General Medicine or Family Medicine or Medical-Pediatrics departments, AND
Inpatient class is Inpatient or Observation or Obs Greater than 48 hours or Outpatient in a Bed or Extended Recovery or Hospital Care at Home Inpatient or Hospital Care at Home Observation, AND
Discharged from General Medicine or Family Medicine or Medicine Observation services, AND
Disposition of home or home with home care

Exclusion

Physician Organization of Michigan Accountable Care Organization (POM ACO)
Sepsis patients (had a diagnosis of sepsis during admission, active or resolved on the hospital problem list)

What this trial measures

  • The number of 30-day all-cause unplanned readmission or death30 calendar days following the index discharge

    An unplanned readmission is defined as any not canceled inpatient, outpatient, or observation hospital admission with an admission type not recorded as "scheduled." Deaths are determined using the Michigan Death Index and matched to patient records using Social Security numbers.