Key result
Older adults hospitalized for AMI who reported being asked about help needed at home had a significantly lower risk of emergency department utilization within 30 days of discharge (adjusted OR 0.65).
Why the study?
Transitions home from the hospital are high-risk for older patients, but little is known about how patient-reported discharge quality relates to clinical outcomes.
Does patient-reported assessment of help needed at home reduce emergency department utilization and rehospitalization within 30 days of discharge in older adults hospitalized with AMI?
Cohort (n=2,132)
Yes
Does patient-reported assessment of help needed at home reduce emergency department utilization and rehospitalization within 30 days of discharge in older adults hospitalized with AMI?
Odds Ratio: 0.65 (95% CI 0.42–0.997)
p-value: p=0.049
In older adults hospitalized with AMI, assessing the need for help at home prior to discharge is associated with a significant reduction in 30-day emergency department utilization.
Home support after AMI discharge was associated with fewer ED visits in older adults; leaves open whether discharge quality interventions affect readmissions.
BACKGROUND: Transitions from hospital to home in older patients are a high-risk period for adverse outcomes in a population that may have more challenges navigating the healthcare system. There is little information about the association of patient-reported quality of hospital discharge processes with clinical outcomes. OBJECTIVES: We evaluated whether patient-reported quality of hospital discharge processes was associated with emergency department utilization and rehospitalization within 30 days of discharge after hospitalization for acute myocardial infarction (AMI) in older adults. DESIGN: Multi-center, prospective cohort study. PATIENTS: The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study was a longitudinal study of 3006 adults age 75 and older hospitalized with AMI recruited from 94 academic and community hospitals from across the USA. INTERVENTION: N/A MAIN MEASURES: Patients answered a subset of questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Readmissions and emergency department utilization within 30 days of discharge were ascertained through medical record review. KEY RESULTS: A total of 2132 patients were included in the study. Patients' median age was 81 years and the response rate to the survey of discharge quality was 87%. Patients who reported being asked about having the help they needed at home were significantly less likely to have emergency room utilization within 30 days of discharge in both the unadjusted (0.65, 95% CI 0.43-0.99) and adjusted (0.65, 95% CI 0.42-0.997) models, though there was no significant association with readmission. CONCLUSION: Report of an assessment of help needed at home during hospitalization was associated with lower post-discharge emergency department utilization. Efforts to improve outcomes after hospital discharge in older patients may benefit from greater focus on assessing need of help at home.
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Richards et al. (2019) conducted a cohort in Acute myocardial infarction (AMI) (n=2,132). Patient report of being asked about help needed at home vs. No report of being asked about help needed at home was evaluated on Emergency department utilization within 30 days of discharge (OR 0.65, 95% CI 0.42-0.997, p=0.049). Older adults hospitalized for AMI who reported being asked about help needed at home had a significantly lower risk of emergency department utilization within 30 days of discharge (adjusted OR 0.65).
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