A Nurse-Led Bridging Program to Reduce 30-Day Readmissions of Older Patients Discharged From Acute Care Units

被引：10

作者：

Gilbert, Thomas ^{[1
,2
]}

Occelli, Pauline ^{[2
,3
]}

Rabilloud, Muriel ^{[4
,5
,6
,7
]}

Poupon-Bourdy, Stephanie ^{[2
,3
]}

Riche, Benjamin ^{[4
,5
,6
,7
]}

Touzet, Sandrine ^{[2
,3
]}

Bonnefoy, Marc ^{[1
,4
,5
,8
]}

机构：

[1] CHU Lyon, Hosp Civils Lyon, Groupement Hosp Sud, Serv Med Geriatr, F-69495 Benite Pierre, France

[2] Univ Claude Bernard lyon 1, HESPER, EA 7425, Lyon 8, France

[3] Hosp Civils Lyon, Serv Rech Clin & Epidemiol, Pole Sante Publ, Lyon, France

[4] Univ Lyon, F-69000 Lyon, France

[5] Univ Lyon 1, Villeurbanne, France

[6] Hosp Civils Lyon, Serv Biostat & Bioinformat, Pole Sante Publ, Lyon, France

[7] CNRS, UMR 5558, Lab Biometrie & Biol Evolut, Equipe Biostat Sante, Villeurbanne, France

[8] CarMeN, INSERM, U1060, Oullins, France

来源：

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION | 2021年 / 22卷 / 06期

关键词：

Patient readmission; older adults; patient discharge; case management; quality of health care; randomized controlled trials as topic; HOSPITAL READMISSIONS; TRANSITIONAL CARE; VISITS; ADULTS; RISK; REHOSPITALIZATIONS; INTERVENTIONS; MEDICATION; MANAGEMENT; OUTCOMES;

D O I：

10.1016/j.jamda.2020.09.015

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Objectives: Older hospitalized patients are at high risk of early readmissions, requiring the implementation of enhanced coordinated transition programs on discharge. The objective of this study was to evaluate the impact of a nurse-led transition bridging program on the rate of unscheduled readmissions of older patients within 30 days from discharge from geriatric acute care units. Design: A stepped-wedge cluster randomized trial. Setting and Participants: Seven hundred five patients aged > 75 years hospitalized in one of 10 acute geriatric units, with at least 2 readmission risk-screening criteria (derived from the Triage Risk Screening Tool), were included from July 2015 to August 2016. Methods: The intervention condition consisted in a nurse-led hospital-to-home bridging program with 4 weeks postdischarge follow-up (2 home visits and 2 telephone calls). Unscheduled hospital readmission or emergency department (ED) visits were compared in intervention and control condition within 30 days from discharge. Results: The rate of 30-day readmission or ED visit was 15.5% in the intervention condition vs 17.6% in the control condition [hazard ratio stratified on clusters: 0.61 (upper limit unilateral 95% confidence interval = 1.11), P = .09]. Rate of presence of professional caregivers was increased in the intervention condition (P < .001). Conclusions and Implications: Although the intervention resulted in an increase in the rate of implementation of a package of care at the 4-week of follow-up, we could not demonstrate a reduction in the rate of 30-day readmissions or ED visits of older patients at risk of readmission. These findings support the evaluation of this type of program on the longer term. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页码：1292 / +

页数：13

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