A transition care coordinator model reduces hospital readmissions and costs.
Adult
Aged
Aged, 80 and over
Comorbidity
Evidence-Based Practice
Female
Heart Failure
/ therapy
Humans
Male
Middle Aged
Nursing Staff, Hospital
/ organization & administration
Patient Readmission
/ statistics & numerical data
Pneumonia
/ therapy
Pulmonary Disease, Chronic Obstructive
/ therapy
Quality Improvement
/ organization & administration
Retrospective Studies
Socioeconomic Factors
Transitional Care
/ organization & administration
And health services research
Care transitions
Quality improvement
Journal
Contemporary clinical trials
ISSN: 1559-2030
Titre abrégé: Contemp Clin Trials
Pays: United States
ID NLM: 101242342
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
28
11
2018
revised:
01
04
2019
accepted:
24
04
2019
pubmed:
29
4
2019
medline:
4
9
2020
entrez:
29
4
2019
Statut:
ppublish
Résumé
The optimal structure and intensity of interventions to reduce hospital readmission remains uncertain, due in part to lack of head-to-head comparison. To address this gap, we evaluated two forms of an evidence-based, multi-component transitional care intervention. A quasi-experimental evaluation design compared outcomes of Transition Care Coordinator (TCC) Care to Usual Care, while controlling for sociodemographic characteristics, comorbidities, readmission risk, and administrative factors. The study was conducted between January 1, 2013 and April 30, 2015 as a quality improvement initiative. Eligible adults (N = 7038) hospitalized with pneumonia, congestive heart failure, or chronic obstructive pulmonary disease were identified for program evaluation via an electronic health record algorithm. Nurse TCCs provided either a full intervention (delivered in-hospital and by post-discharge phone call) or a partial intervention (phone call only). A total of 762 hospitalizations with TCC Care (460 full intervention and 302 partial intervention) and 6276 with Usual Care was examined. In multivariable models, hospitalizations with TCC Care had significantly lower odds of readmission at 30 days (OR = 0.512, 95% CI 0.392 to 0.668) and 90 days (OR = 0.591, 95% CI 0.483 to 0.723). Adjusted costs were significantly lower at 30 days (difference = $3969, 95% CI $5099 to $2691) and 90 days (difference = $5684, 95% CI $7602 to $3627). The effect was similar whether patients received the full or partial intervention. An evidence-based multi-component intervention delivered by nurse TCCs reduced 30- and 90-day readmissions and associated health care costs. Lower intensity interventions delivered by telephone after discharge may have similar effectiveness to in-hospital programs.
Sections du résumé
BACKGROUND
The optimal structure and intensity of interventions to reduce hospital readmission remains uncertain, due in part to lack of head-to-head comparison. To address this gap, we evaluated two forms of an evidence-based, multi-component transitional care intervention.
METHODS
A quasi-experimental evaluation design compared outcomes of Transition Care Coordinator (TCC) Care to Usual Care, while controlling for sociodemographic characteristics, comorbidities, readmission risk, and administrative factors. The study was conducted between January 1, 2013 and April 30, 2015 as a quality improvement initiative. Eligible adults (N = 7038) hospitalized with pneumonia, congestive heart failure, or chronic obstructive pulmonary disease were identified for program evaluation via an electronic health record algorithm. Nurse TCCs provided either a full intervention (delivered in-hospital and by post-discharge phone call) or a partial intervention (phone call only).
RESULTS
A total of 762 hospitalizations with TCC Care (460 full intervention and 302 partial intervention) and 6276 with Usual Care was examined. In multivariable models, hospitalizations with TCC Care had significantly lower odds of readmission at 30 days (OR = 0.512, 95% CI 0.392 to 0.668) and 90 days (OR = 0.591, 95% CI 0.483 to 0.723). Adjusted costs were significantly lower at 30 days (difference = $3969, 95% CI $5099 to $2691) and 90 days (difference = $5684, 95% CI $7602 to $3627). The effect was similar whether patients received the full or partial intervention.
CONCLUSION
An evidence-based multi-component intervention delivered by nurse TCCs reduced 30- and 90-day readmissions and associated health care costs. Lower intensity interventions delivered by telephone after discharge may have similar effectiveness to in-hospital programs.
Identifiants
pubmed: 31029692
pii: S1551-7144(18)30671-2
doi: 10.1016/j.cct.2019.04.014
pmc: PMC6559370
mid: NIHMS1529210
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
55-61Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000445
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
JAMA. 1999 Feb 17;281(7):613-20
pubmed: 10029122
J Health Econ. 2004 May;23(3):525-42
pubmed: 15120469
Arch Intern Med. 2006 Sep 25;166(17):1822-8
pubmed: 17000937
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Ann Intern Med. 2009 Feb 3;150(3):178-87
pubmed: 19189907
Med Care. 2009 Jun;47(6):626-33
pubmed: 19433995
CMAJ. 2010 Apr 6;182(6):551-7
pubmed: 20194559
Health Econ. 2011 Aug;20(8):897-916
pubmed: 20799344
Ann Intern Med. 2011 Oct 18;155(8):520-8
pubmed: 22007045
JAMA. 2011 Oct 19;306(15):1688-98
pubmed: 22009101
N Engl J Med. 2012 Apr 12;366(15):1366-9
pubmed: 22455752
Ann Intern Med. 2012 Jul 3;157(1):1-10
pubmed: 22751755
J Am Coll Cardiol. 2012 Aug 14;60(7):607-14
pubmed: 22818070
J Hosp Med. 2013 Feb;8(2):102-9
pubmed: 23184714
J Hosp Med. 2013 Aug;8(8):421-7
pubmed: 23873709
Annu Rev Med. 2014;65:471-85
pubmed: 24160939
Jt Comm J Qual Patient Saf. 2014 Feb;40(2):68-76
pubmed: 24716329
BMC Health Serv Res. 2014 Sep 23;14:423
pubmed: 25244946
Acad Med. 2016 Apr;91(4):522-9
pubmed: 26579793
J Gen Intern Med. 2016 May;31(5):470-7
pubmed: 26883526
JAMA Intern Med. 2016 Apr;176(4):496-502
pubmed: 26954698
JAMA Intern Med. 2016 May 1;176(5):681-90
pubmed: 27065180
JAMA. 2016 Jun 14;315(22):2397-8
pubmed: 27213914
J Hosp Med. 2017 Nov;12(11):918-924
pubmed: 29091980
Ann Intern Med. 1994 Jun 15;120(12):999-1006
pubmed: 8185149