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Evaluating Intervention Allocation Policies for Reducing Hospital Readmissions at Michigan Medicine

Who can join

Ages 18 and older · All sexes

Inclusion Criteria:

* 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 Criteria:

* 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)

About the study

The researchers are investigating if using a risk-based prediction score or benefit-based prediction score to allocate transition of care (TOC) interventions is more effective in reducing the rate of unplanned hospital readmissions or death within 30 days of hospital discharge.

What is being tested

• C-HARP TOC assignment (device)
• The LACE Index TOC assignment (other)

Sponsor: University of Michigan · Participants: 5,000 · Started: Jul 13, 2026

Contact the study team

• Stephanie Shepard, PhD · Phone: 734-647-1098

Official record on ClinicalTrials.gov — NCT07690657

Locations in the U.S.

Conditions

• End of Life Issues

From ClinicalTrials.gov, data retrieved Nov 15, 2026. Each study sets its own eligibility; the study team decides who can join.