Key result
A multifaceted care transitions intervention cuts postdischarge adverse events ~45% vs usual care.
Why the study?
Transitions from hospital to ambulatory care are high risk for adverse events, poor outcomes, and readmission, motivating evaluation of a multifaceted care transitions intervention.
Does a multifaceted care transitions intervention reduce postdischarge adverse events in adult patients admitted to a medical or surgical service within an accountable care organization?
RCT (n=1,679)
Single-blind
Stepped-wedge cluster-randomized
Yes
Does a multifaceted care transitions intervention reduce postdischarge adverse events in adult patients admitted to a medical or surgical service within an accountable care organization?
Relative Risk: 0.55 (95% CI 0.35–0.84)
Absolute Event Rate: 18% vs 23%
A multifaceted care transitions intervention significantly reduced postdischarge adverse events but did not impact 30-day hospital readmission rates.
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May reduce postdischarge adverse events in ACO settings; leaves open effects on readmissions and broader implementation.
BACKGROUND: Transitions from hospital to the ambulatory setting are high risk for patients in terms of adverse events, poor clinical outcomes, and readmission. OBJECTIVES: To develop, implement, and refine a multifaceted care transitions intervention and evaluate its effects on postdischarge adverse events. DESIGN, SETTING, AND PARTICIPANTS: Two-arm, single-blind (blinded outcomes assessor), stepped-wedge, cluster-randomized clinical trial. Participants were 1,679 adult patients who belonged to one of 17 primary care practices and were admitted to a medical or surgical service at either of two participating hospitals within a pioneer accountable care organization (ACO). INTERVENTIONS: Multicomponent intervention in the 30 days following hospitalization, including inpatient pharmacist-led medication reconciliation, coordination of care between an inpatient "discharge advocate" and a primary care "responsible outpatient clinician," postdischarge phone calls, and postdischarge primary care visit. MAIN OUTCOMES AND MEASURES: The primary outcome was rate of postdischarge adverse events, as assessed by a 30-day postdischarge phone call and medical record review and adjudicated by two blinded physician reviewers. Secondary outcomes included preventable adverse events, new or worsening symptoms after discharge, and 30-day nonelective hospital readmission. RESULTS: Among patients included in the study, 692 were assigned to usual care and 987 to the intervention. Patients in the intervention arm had a 45% relative reduction in postdischarge adverse events (18 vs 23 events per 100 patients; adjusted incidence rate ratio, 0.55; 95% CI, 0.35-0.84). Significant reductions were also seen in preventable adverse events and in new or worsening symptoms, but there was no difference in readmission rates. CONCLUSION: A multifaceted intervention was associated with a significant reduction in postdischarge adverse events but no difference in 30-day readmission rates.
Schnipper et al. (2020) conducted an RCT in Hospital discharge / Care transitions (n=1,679). Multifaceted care transitions intervention vs. Usual care was evaluated on Rate of postdischarge adverse events (adjusted IRR 0.55, 95% CI 0.35-0.84). A multifaceted care transitions intervention significantly reduced postdischarge adverse events compared to usual care (18 vs 23 events per 100 patients; adjusted IRR 0.55; 95% CI 0.35-0.84).
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