The Mi Puente discharge program unexpectedly increased hospital use relative to usual care, with process evaluation revealing 75% acceptance but only 70% per-protocol delivery and resource gaps.
RCT
Does a culturally appropriate, team-based discharge program reduce readmission rates in Hispanic/Latino adults with multimorbidity compared to usual care?
A process evaluation of the Mi Puente care transitions program revealed gaps in intervention delivery and community resources that may explain the unexpected increase in hospital use observed in the trial.
OBJECTIVE The Mi Puente (My Bridge) randomized controlled trial compared a culturally appropriate, team-based discharge program versus usual discharge procedures (usual care) in reducing readmission rates (inpatient, emergency, and observation visits) among Hispanic/Latino adults with multimorbidity. Primary outcome analyses revealed the Mi Puente group demonstrated increased hospital use relative to usual care. To better understand these unexpected effectiveness findings and inform future research, we conducted a multimethod process evaluation using components of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESEARCH DESIGN AND METHODS Reach was assessed by examining the proportion of eligible participants enrolled and representativeness of the sample. Adoption was assessed via semistructured interviews with study staff. Implementation was examined using study fidelity forms (e.g., protocol adherence and duration/content of visits) and whether those who received the intervention per protocol differed from those who did not. RESULTS Mi Puente reached the target population, with high acceptance among eligible patients enrolled (75%), although participants tended to be younger, preferred English, and endorsed more behavioral health concerns. Adoption interviews and related Implementation findings revealed gaps in both the intervention content delivered and the availability of resources within San Diego County. Approximately 70% of participants received the intervention per protocol. CONCLUSIONS Multilevel strategies are needed to improve post-discharge outcomes in Hispanic/Latino adults with multimorbidity. These should include improved integration of inpatient and outpatient settings, the use of warm handoffs and home visits, ongoing clinical support, and implementation of structural-level interventions to address social determinants of health.
Clark et al. (Tue,) conducted a rct in Multimorbidity. Mi Puente (My Bridge) care transitions program vs. Usual discharge procedures was evaluated on Readmission rates (inpatient, emergency, and observation visits). The Mi Puente discharge program unexpectedly increased hospital use relative to usual care, with process evaluation revealing 75% acceptance but only 70% per-protocol delivery and resource gaps.