Can asking patients about their needs reduce hospital visits?

NCT ID NCT05820295

First seen Jun 26, 2026 · Last updated Jun 26, 2026

Summary

This study looked at two ways to assign care coordinators to older adults (65+) with heart disease or risk factors. One method used patients' own reports of difficulty coordinating care, while the other used usual triggers like hospital discharge. The goal was to see which approach better reduced emergency room visits and hospitalizations. The trial involved 400 Medicare beneficiaries and was completed in a real-world healthcare setting.

What this could mean

Our plain-language read of the trial. This is informational only — not medical advice or a prediction.

Active substance

care coordination (behavioral intervention)

What this could lead to

If successful, this could show that assigning care coordinators based on patients' own reports of difficulty is better than the usual method, potentially reducing hospital visits.

What could go wrong

This is a completed pragmatic trial, so results are available but may not apply to all healthcare systems. The intervention is behavioral, not a drug, so benefits may be modest.

Disclaimer Read more

This is a summary of the original study . Summaries may miss details or leave out important information. Before applying or accepting participation, make sure you have read and understood the full study. Curemydisease.com takes no responsibility whatsoever for anything missed, misunderstood, or acted upon as a result of our summary — we know it does not capture everything.

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Conditions

The condition(s) this trial relates to.

atrial fibrillation cardiovascular disorder diabetes mellitus heart failure hyperlipidemia hypertensive disorder myocardial infarction myocardial ischemia stroke disorder transient ischemic attack

As listed by the trial registrant

The condition terms exactly as the trial's registrant entered them.

Contacts and locations

Locations

  • New York Presbyterian Hospital - Weill Cornell Medicine

    New York, New York, 10065, United States