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Showing 1–16 of 16 matching trials from the live ClinicalTrials.gov search.
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Filters: Condition: Post-discharge Care Transitions Clear all
Completed Not applicable Interventional

An Automatic Notification System for Test Results Finalized After Discharge

NCT01153451
View directory record Official record
Conditions
Test Result Management
Interventions
Email Notification
Other
Lead sponsor
Brigham and Women's Hospital
Other
Eligibility
18 Years and older
Enrollment
441 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2010 – 2012
U.S. locations
1
States / cities
Boston, Massachusetts
Source: ClinicalTrials.gov public record
Updated Jun 4, 2013 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional

The Impact of a Personalized Care Intervention on 90-day Post-Discharge Care

NCT06146582
View directory record Official record
Conditions
Cardiovascular Diseases
Interventions
Laguna Coach and App Intervention Group
Behavioral
Lead sponsor
Laguna Health, Inc
Industry
Eligibility
18 Years and older
Enrollment
187 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2021 – 2023
U.S. locations
1
States / cities
Rochester, Minnesota
Source: ClinicalTrials.gov public record
Updated Mar 19, 2024 · Synced Jul 22, 2026, 4:14 PM EDT
Enrolling by invitation Not applicable Interventional

Effectiveness of mHealth Post-discharge Intervention for Patients With Severe Mental Illness

NCT05703412
View directory record Official record
Conditions
Bipolar Disorder, Major Depression, Schizophrenia
Interventions
Transition-FOCUS mHealth Intervention, Check-In
Behavioral
Lead sponsor
Butler Hospital
Other
Eligibility
18 Years and older
Enrollment
180 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2023 – 2027
U.S. locations
1
States / cities
Providence, Rhode Island
Source: ClinicalTrials.gov public record
Updated Jun 5, 2025 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional Results available

CAPABLE Transitions: A Home Health-Based Intervention for the Hospital or Post-Acute Care Facility-to-Home Transition

NCT04460742
View directory record Official record
Conditions
Care Transitions, Dementia
Interventions
CAPABLE Transitions, Home Health Agency Care
Behavioral
Lead sponsor
University of Rochester
Other
Eligibility
65 Years and older
Enrollment
31 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2021 – 2023
U.S. locations
1
States / cities
Rochester, New York
Source: ClinicalTrials.gov public record
Updated Jul 31, 2023 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional Accepts healthy volunteers

Community Health Worker Care Transitions Study

NCT03085264
View directory record Official record
Conditions
Hospitalism
Interventions
Community Health Worker
Behavioral
Lead sponsor
Massachusetts General Hospital
Other
Eligibility
18 Years to 109 Years
Enrollment
600 participants
Healthy volunteers
Accepts healthy volunteers
Timeline
2017 – 2019
U.S. locations
1
States / cities
Boston, Massachusetts
Source: ClinicalTrials.gov public record
Updated Feb 23, 2020 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional Accepts healthy volunteers

PREventing Adverse Events Post-Discharge Through Proactive Identification, Multidisciplinary Communication, and Technology

NCT05232656
View directory record Official record
Conditions
Transitions of Care, General Medicine, Discharge Checklist, Adverse Event
Interventions
Pre-Discharge Checklist and Patient Safety Dashboard
Behavioral
Lead sponsor
Brigham and Women's Hospital
Other
Eligibility
18 Years and older
Enrollment
268 participants
Healthy volunteers
Accepts healthy volunteers
Timeline
2018 – 2020
U.S. locations
1
States / cities
Boston, Massachusetts
Source: ClinicalTrials.gov public record
Updated Feb 9, 2022 · Synced Jul 22, 2026, 4:14 PM EDT
Not yet recruiting Not applicable Interventional

MEDBRIDGE-Guided NCM/CHW Post-Discharge Support for High-Risk T2D Patients

NCT07599852
View directory record Official record
Conditions
Type 2 Diabetes, Medication Adherence, Care Transition, Medication Discrepancy
Interventions
MEDBRIDGE-Guided NCM/CHW Post-Discharge Support Intervention
Behavioral
Lead sponsor
University of Alabama at Birmingham
Other
Eligibility
18 Years and older
Enrollment
45 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2029 – 2031
U.S. locations
2
States / cities
Birmingham, Alabama
Source: ClinicalTrials.gov public record
Updated May 19, 2026 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional

Evaluating Sequential Strategies to Reduce Readmission in a Diverse Population

NCT01619098
View directory record Official record
Conditions
Hospital Readmission, Post-discharge Care Transitions, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease
Interventions
Patient Navigator, Usual care
Other
Lead sponsor
Alison Galbraith
Other
Eligibility
18 Years and older
Enrollment
1,510 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2011 – 2013
U.S. locations
2
States / cities
Cambridge, Massachusetts • Everett, Massachusetts
Source: ClinicalTrials.gov public record
Updated Jan 21, 2014 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional

MORE-PC: A 30-day Automated SMS Program to Support Post-discharge Transitions of Care

NCT05245773
View directory record Official record
Conditions
Care Transitions
Interventions
Automated SMS program to support post-discharge transitions of care
Other
Lead sponsor
University of Pennsylvania
Other
Eligibility
18 Years and older
Enrollment
5,000 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2022 – 2023
U.S. locations
1
States / cities
Philadelphia, Pennsylvania
Source: ClinicalTrials.gov public record
Updated Feb 26, 2023 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional Accepts healthy volunteers

Interactive Digital Health Tools to Improve Patient Safety in Acute Care

NCT03116074
View directory record Official record
Conditions
Transitions of Care, Patient Portals, General Medicine, Discharge Checklist, Patient-provider Communication, Adverse Event, Readmission
Interventions
Interactive Digital Health Tools
Behavioral
Lead sponsor
Brigham and Women's Hospital
Other
Eligibility
18 Years and older
Enrollment
750 participants
Healthy volunteers
Accepts healthy volunteers
Timeline
2017 – 2020
U.S. locations
1
States / cities
Boston, Massachusetts
Source: ClinicalTrials.gov public record
Updated Jul 24, 2022 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional Accepts healthy volunteers

Using Health Information Technology (HIT) to Improve Transitions of Complex Elderly Patients From Skilled Nursing Facility (SNF) to Home

NCT01004328
View directory record Official record
Conditions
Adverse Outcomes
Interventions
Intervention 1: Electronic medical record (EMR)-based transitional care intervention
Other
Lead sponsor
University of Massachusetts, Worcester
Other
Eligibility
65 Years and older
Enrollment
626 participants
Healthy volunteers
Accepts healthy volunteers
Timeline
2011 – 2013
U.S. locations
1
States / cities
Worcester, Massachusetts
Source: ClinicalTrials.gov public record
Updated Apr 23, 2014 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional

Testing the Efficacy of a Post-discharge Call Program on the Rate of Readmission

NCT03683797
View directory record Official record
Conditions
Care Transitions
Interventions
Post-discharge call
Other
Lead sponsor
NYU Langone Health
Other
Eligibility
Not listed
Enrollment
3,267 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2018 – 2019
U.S. locations
1
States / cities
New York, New York
Source: ClinicalTrials.gov public record
Updated Jul 19, 2021 · Synced Jul 22, 2026, 4:14 PM EDT
Terminated Not applicable Interventional

Behavioral Coaching Intervention (Laguna Health) for Patients With Cancer

NCT06004141
View directory record Official record
Conditions
Cancer
Interventions
Laguna Health
Behavioral
Lead sponsor
Massachusetts General Hospital
Other
Eligibility
18 Years and older
Enrollment
18 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2023 – 2024
U.S. locations
1
States / cities
Boston, Massachusetts
Source: ClinicalTrials.gov public record
Updated Feb 1, 2024 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional

Post-Discharge Follow-up Appointment Scheduling

NCT06387576
View directory record Official record
Conditions
Appointments and Schedules
Interventions
Behaviorally informed pre-discharge iPad video scheduling
Behavioral
Lead sponsor
University of California, Los Angeles
Other
Eligibility
18 Years and older
Enrollment
41 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2024
U.S. locations
1
States / cities
Santa Monica, California
Source: ClinicalTrials.gov public record
Updated Apr 29, 2025 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional

Evaluation of Transitions Clinic: A Post-Release Clinic for Recently Released Parolees With Chronic Medical Conditions

NCT01179035
View directory record Official record
Conditions
Health Services Research, Prisons, Delivery of Health Care, Vulnerable Populations, Community Health Aides
Interventions
Transitions Clinic - parolee-targeted care, Expedited Primary Care
Other
Lead sponsor
Transitions Clinic
Other
Eligibility
18 Years and older
Enrollment
150 participants
U.S. locations
1
States / cities
San Francisco, California
Source: ClinicalTrials.gov public record
Updated Aug 9, 2010 · Synced Jul 22, 2026, 4:14 PM EDT
Completed Not applicable Interventional

Use of a Brief Phone Call After ED Discharge

NCT01893931
View directory record Official record
Conditions
Discharge Planning, Emergency Medicine, Geriatrics, Patient Readmission
Interventions
ED Discharge & Medication Call, Placebo Comparator
Behavioral
Lead sponsor
University of North Carolina, Chapel Hill
Other
Eligibility
65 Years and older
Enrollment
2,003 participants
Healthy volunteers
Healthy volunteers not accepted
Timeline
2013 – 2016
U.S. locations
1
States / cities
Chapel Hill, North Carolina
Source: ClinicalTrials.gov public record
Updated Jul 10, 2016 · Synced Jul 22, 2026, 4:14 PM EDT