A Pilot Randomized Trial of a Comprehensive Transitional Care Program for Colorectal Cancer Patients

Arms (2)

1. type

   EXPERIMENTAL

   label

   Intervention (plus usual care)

   description

   Patient education: One-on-one visit Discharge planning: Assessment of barriers to discharge Medication reconciliation: Patient medication review Appointment before discharge: Additional measure to ensure awareness of next clinic visit Transition coach Patient-centered discharge instructions: Enhanced Provider continuity: Specific surgeons responsible for coordinating care with medical/radiation oncology Timely follow-up: Barriers to clinic follow-up visits will be discussed Timely PCP communication Follow-up telephone call Patient hotline: 24 hour follow-up following call to Ask My Nurse number

   interventionNames

   1. Other: Patient education: One-on-one visit
   2. Other: Discharge planning: Assessment of barriers to discharge
   3. Other: Medication reconciliation: Patient medication review
   4. Other: Appointment before discharge: Additional measure to ensure awareness of next clinic visit
   5. Other: Transition coach
   6. Other: Patient-centered discharge instructions: Enhanced
   7. Other: Provider continuity: Specific surgeons responsible for coordinating care with medical/radiation oncology
   8. Other: Timely follow-up: Barriers to clinic follow-up visits will be discussed
   9. Other: Timely PCP communication
   10. Other: Follow-up telephone call
   11. Other: Patient hotline: 24 hour follow-up following call to Ask My Nurse number