Reduction of 30-Day Postdischarge Hospital Readmission or Emergency Department (ED) Visit Rates in High-Risk Elderly Medical Patients Through Delivery of a Targeted Care Bundle

被引：281

作者：

Koehler, Bruce E. ^{[1
]}

Richter, Kathleen M. ^{[1
]}

Youngblood, Liz ^{[2
]}

Cohen, Brian A. ^{[3
]}

Prengler, Irving D. ^{[4
]}

Cheng, Dunlei ^{[1
]}

Masica, Andrew L. ^{[1
]}

机构：

[1] Baylor Hlth Care Syst, Inst Hlth Care Res & Improvement, Dallas, TX 75206 USA

[2] Baylor Hlth Care Syst, Dept Patient Serv, Dallas, TX 75206 USA

[3] Baylor Hlth Care Syst, Dept Pharm Serv, Dallas, TX 75206 USA

[4] Baylor Hlth Care Syst, Dept Med Staff Affairs, Dallas, TX 75206 USA

来源：

JOURNAL OF HOSPITAL MEDICINE | 2009年 / 4卷 / 04期

关键词：

care coordination; discharge planning; elderly care; hospital readmission; transitional care; DISEASE MANAGEMENT PROGRAMS; CONGESTIVE-HEART-FAILURE; ADVERSE DRUG EVENTS; QUALITY-IMPROVEMENT; OLDER-PEOPLE; HOME; INTERVENTION; DISCHARGE; OUTCOMES; MULTIDISCIPLINARY;

D O I：

10.1002/jhm.427

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

RATIONALE: Care coordination has shown inconsistent results as a mechanism to reduce hospital readmission and postdischarge emergency department (ED) visit rates. OBJECTIVE: To assess the impact of a supplemental care bundle targeting high-risk elderly inpatients implemented by hospital-based staff compared to usual care on a composite Outcome of hospital readmission and/or ED visitation at 30 and 60 days following discharge. PATIENTS/METHODS: Randomized controlled pilot study in 41 medical inpatients predisposed to unplanned readmission or postdischarge ED visitation, conducted at Baylor University Medical Center. The intervention group care bundle consisted of medication counseling/reconciliation by a clinical pharmacist (CP), condition specific education/enhanced discharge planning by a care coordinator (CC), and phone follow-up. RESULTS: Groups had similar baseline characteristics. Intervention group readmission/ED visit rates were reduced at 30 days compared to the control group (10.0% versus 38.1%, P = 0.04), but not at 60 days (30.0% versus 42.9%, P = 0.52). For those patients who had a readmission/postdischarge ED visit, the time interval to this event was longer in the intervention group compared to usual care (36.2 versus 15.7 days, P = 0.05). Study power was insufficient to reliably compare the effects of the intervention on lengths of index hospital stay between groups. CONCLUSIONS: A targeted care bundle delivered to high-risk elderly inpatients decreased unplanned acute health care utilization up to 30 days following discharge. Dissipation of this effect by 60 days postdischarge defines reasonable expectations for analogous hospital-based educational interventions. Further research is needed regarding the impacts of similar care bundles in larger Populations across a variety of inpatient settings. Journal of Hospital Medicine 2009;4:211-218. (C) 2009 Society of Hospital Medicine.

引用

页码：211 / 218

页数：8

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