Key result
The RED-D telehealth intervention did not significantly reduce 30-day hospital readmissions compared to standard discharge planning in the intention-to-treat analysis (9% vs 10%, IRR 0.92).
Why the study?
To determine if hospitalized patients with depressive symptoms benefit from post-discharge depression treatment combined with care transition support.
Does a 12-week post-discharge telehealth intervention (RED-D) reduce hospital readmission and reutilization in hospitalized patients with depressive symptoms compared to standard discharge support?
RCT (n=709)
Open-label
Block randomization
Yes
Does a 12-week post-discharge telehealth intervention (RED-D) reduce hospital readmission and reutilization in hospitalized patients with depressive symptoms compared to standard discharge support?
Relative Risk: 0.92 (95% CI 0.56–1.52)
Absolute Event Rate: 9% vs 10%
p-value: p=0.758
While intention-to-treat analysis showed no overall benefit, as-treated analysis suggests that post-discharge depression treatment and care transition support can reduce unplanned hospital use if patients sufficiently adhere to the intervention.
Post-discharge RED-D reduces readmissions in depressed inpatients; extends care-transition benefits to this high-risk population.
PURPOSE: To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support. METHODS: This is a randomized controlled trial of hospitalized patients with patient health questionnaire-9 score of 10 or more. We delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention including cognitive behavioral therapy, self-management support, and patient navigation. Primary outcomes were hospital readmission and reutilization rates at 30 and 90 days post discharge. RESULTS: We randomized 709 participants (353 RED-D, 356 RED-only). At 90 days, 265 (75%) intervention participants had received at least 1 RED-D session (median 4). At 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission (9% vs 10%, incidence rate ratio [IRR] 0.92 [95% CI, 0.56-1.52]) or reutilization (27% vs 24%, IRR 1.14 [95% CI, 0.85-1.54]). The intention-to-treat analysis also showed no differences at 90 days in readmission (28% vs 21%, IRR 1.30 [95% CI, 0.95-1.78]) or reutilization (70% vs 57%, IRR 1.22 [95% CI, 1.01-1.49]). In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions (3% vs 10%, IRR 0.30 [95% CI, 0.07-0.84]) compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions (11% vs 21%, IRR 0.52 [95% CI, 0.27-0.92]). Intention-to-treat analysis showed no differences between study groups on secondary outcomes. CONCLUSIONS: Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.
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Mitchell et al. (2022) conducted an RCT in Depressive symptoms in hospitalized patients (n=709). Re-Engineered Discharge for Depression (RED-D) vs. Re-Engineered Discharge (RED) alone was evaluated on 30-day hospital readmission (IRR 0.92, 95% CI 0.56-1.52, p=0.758). The RED-D telehealth intervention did not significantly reduce 30-day hospital readmissions compared to standard discharge planning in the intention-to-treat analysis (9% vs 10%, IRR 0.92).
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