Programs designed to help transition care for hospitalized older patients to outside healthcare clinicians and settings are associated with reduced rates of hospital readmissions, according to two new reports in the Archives of Internal Medicine.
“In the United States, 30-day all-cause readmission rates for patients 65 years or older generally range from 20% to 25%, depending on clinical condition and geographic region, indicating much room for improvement,” the authors wrote in one report. “Interventions addressing patient- and systems-level factors show promise for reducing hospital admissions.”
In one report, Rachel Voss, MPH, of Quality Partners of Providence, R.I., and colleagues examined the effects of the an intervention in reducing hospital readmissions. The Care Transitions Intervention, which took place over 30 days, included a “coach” who completed a hospital visit, a home visit and two follow-up telephone calls with the patient.
Between January 2009 and June 2010, the authors recruited patients at six Rhode Island acute care hospitals for participation in the intervention. Patients were separated into three groups: intervention group, internal control group (patients who were approached but declined the intervention or did not complete the home visit) and external control group (patients who were not approached but eligible for participation based on study criteria).
Of the 1,888 patients approached for the study, 1,042 (55.2%) agreed to participate and of those, 257 (24.7%) completed the full intervention with home visit. The odds of hospital readmission within 30 days of discharge were significantly lower for patients participating in the intervention compared with those who were never approached for participation (12.8% readmission rate vs. 20% readmission rate). Individuals in the internal control group had readmission rates similar to those of the external control group (18.6%).
The authors concluded that “the Care Transitions Intervention appears to be effective in this real-world implementation. This finding underscores the opportunity to improve health outcomes beginning at the time of discharge in open healthcare settings.”
In a second article, Brett D. Stauffer, MD, MHS, of the Institute for Health Care Research and Improvement at Baylor Health Care System in Dallas, evaluated an advanced practice nurse-led transitional care program for patients 65 years and older with heart failure who were discharged from Baylor Medical Center Garland from August 2009 through April 2010.
The program included a pre-discharge intervention by the advanced practice nurse and at least eight post-discharge house calls per patient.
The study examined the association between the transitional program and 30-day (from discharge) all-cause readmission rate, length of stay and 60-day (from admission) direct cost for BMCG with that of other hospitals within the Baylor Health Care System.
During the study period, 140 Medicare patients with heart failure were eligible for the intervention and of these, 56 (40%) enrolled in the study. The adjusted 30-day readmission rate was 48% lower at BMCG after the intervention than before, but the intervention had little effect on hospital length of stay or total 60-day direct costs for the center compared to other hospitals in the Baylor system.
“Preliminary results suggest that transitional care programs reduce 30-day readmission rates for patients with heart failure,” the authors concluded. “This underscores the potential of the intervention to be effective in a real-world setting, but payment reform may be required for the intervention to be financially sustainable by hospitals.”
The studies ran in the July 25 edition of AIM. View them at http://archinte.ama-assn.org/cgi/content/short/171/14/1232 and http://archinte.ama-assn.org/cgi/content/short/171/14/1238.