Abstract
OBJECTIVES: To test the effectiveness of a multicomponent care transition intervention targeted at hospitalized patients, aged 75 years and older, at high risk for hospital readmissions, return emergency department (ED) visits, and related complications. DESIGN: Implementation as a quality improvement program with propensity-matched preintervention and concurrent comparison groups over a 12-month period. SETTING: A 400-bed community teaching hospital. PARTICIPANTS: Patients, aged 75 years and older, admitted to non–intensive care unit beds who met specific high-risk criteria. The intervention group included 202 patients, and the concurrent and preintervention comparison groups included 4142 and 4592 patients, respectively. MEASUREMENTS: Primary outcomes were 30-day hospital readmissions and returns to the ED; 7-day readmissions and ED visits were secondary measures. RESULTS: Among the 202 patients enrolled in the “Safe Transitions for At-Risk Patients” (“STAR”) program, 37 (18.3%) were readmitted within 30 days, in contrast to 14.3% and 14.6% in the concurrent and preintervention comparison groups, respectively. Rates for 30-day return ED visits that did not result in hospitalization were 10.9% in the intervention group, and 7.2% and 7.9% in the comparison groups. STAR patients had greater 30-day ED use than patients in the preintervention comparison group (5.0 percentage points; 95% confidence interval = 0.8-9.3 percentage points; P =.020). Implementation challenges included suboptimal involvement of the participating hospital and post–acute care organizations and a relatively high proportion of patients who did not receive the intervention as planned, despite agreeing to participate before leaving the hospital. CONCLUSION: A multicomponent care transitions intervention targeting high-risk patients, aged 75 years and older, admitted to a community teaching hospital was not effective in reducing 30- or 7-day readmissions or return ED visits. Our implementation experience offers many lessons for future programs for similar high-risk geriatric populations. J Am Geriatr Soc 67:2634–2642, 2019.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2634-2642 |
| Number of pages | 9 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 67 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2019 |
Bibliographical note
Funding Information:This project was supported by a patient safety grant from the Florida Medical Malpractice Joint Underwriting Association.
Funding Information:
The authors thank Dr Robert Kane, now deceased, who was involved in the conceptualization of this program and the evaluation design; Jill Shutes, NP, who assisted in initial program implementation; and the information technology staff of Boca Raton Regional Hospital for facilitating data acquisition from the hospital electronic record. This project was supported by a patient safety grant from the Florida Medical Malpractice Joint Underwriting Association. Dr Ouslander is a full-time employee of Florida Atlantic University (FAU) and has received support through FAU for research on Interventions to Reduce Acute Care Transfers (INTERACT) from the National Institutes of Health, the Centers for Medicare and Medicaid Services, The Commonwealth Fund, the Retirement Research Foundation, the Florida Medical Malpractice Joint Underwriting Association, PointClickCare, Medline Industries, and Think Research. Dr Ouslander and his wife had ownership interest in INTERACT Training, Education, and Management (?I TEAM?) Strategies, LLC, which had a license agreement with FAU for use of INTERACT materials and trademark for training during the time of the study, and now receive royalties from Pathway Health, which currently holds the license. Dr Ouslander serves as a paid advisor to Pathway Health, Think Research, and Curavi. Work on funded INTERACT research is subject to the terms of Conflict of Interest Management plans developed and approved by the FAU Financial Conflict of Interest Committee. Drs Engstrom and Reyes receive support from PointClickCare. Peter J. Huckfeldt, PhD: design, data management, analyses, and writing. Bernardo Reyes, MD: project coordination, design, data collection, analyses, and writing. Gabriella Engstrom, PhD, RN: project coordination, design, data collection, data management, and writing. Qingnan Yang: data analyses. Sanya Diaz, NP: project coordination, design, data collection, and data management. Samer Fahmy, MD: data management and analyses. Joseph G. Ouslander, MD: project oversight, design, data collection, and writing. The Florida Medical Malpractice Joint Underwriting Association was not involved in the design, analysis, interpretation, or authorship of the project.
Funding Information:
Dr Ouslander is a full‐time employee of Florida Atlantic University (FAU) and has received support through FAU for research on Interventions to Reduce Acute Care Transfers (INTERACT) from the National Institutes of Health, the Centers for Medicare and Medicaid Services, The Commonwealth Fund, the Retirement Research Foundation, the Florida Medical Malpractice Joint Underwriting Association, PointClickCare, Medline Industries, and Think Research. Dr Ouslander and his wife had ownership interest in INTERACT Training, Education, and Management (“I TEAM”) Strategies, LLC, which had a license agreement with FAU for use of INTERACT materials and trademark for training during the time of the study, and now receive royalties from Pathway Health, which currently holds the license. Dr Ouslander serves as a paid advisor to Pathway Health, Think Research, and Curavi. Work on funded INTERACT research is subject to the terms of Conflict of Interest Management plans developed and approved by the FAU Financial Conflict of Interest Committee. Drs Engstrom and Reyes receive support from PointClickCare.
Publisher Copyright:
© 2019 The American Geriatrics Society
Keywords
- care transitions
- high-risk geriatric patients
- hospital readmissions