Key result
Social work-based transitional care is linked to ~20% fewer 30-day readmissions among Medicare beneficiaries.
Why the study?
Efforts to reduce hospital readmissions increasingly focus on addressing social and logistical needs alongside clinical challenges during posthospital transitional care.
Does a social work-based transitional care intervention reduce all-cause 30-day readmission rates in Medicare FFS beneficiaries discharged from an urban medical center?
Observational (n=1,546)
No
Does a social work-based transitional care intervention reduce all-cause 30-day readmission rates in Medicare FFS beneficiaries discharged from an urban medical center?
A social work-based transitional care model may effectively reduce 30-day all-cause readmissions among Medicare fee-for-service beneficiaries.
Social work transitional care was associated with 4.5% absolute readmission reduction; leaves open efficacy in randomized trials.
Efforts to reduce readmissions after hospital discharge are increasingly being made to better identify and address social and logistical needs in addition to attending to posthospital clinical challenges. A transitional care model based in the social work professional skill set may be well matched to assess and address social and logistical needs during the posthospital transitional care period. The effect of a social work-based transitional care intervention on all-cause 30-day readmission rates for Medicare fee-for-service (FFS) beneficiaries discharged from an urban medical center was analyzed. Analyses revealed a 20% relative reduction in readmissions for 1,546 Medicare FFS discharges to home, with or without home care (a 4.5% absolute rate reduction). This model may be of interest to entities that are accountable for the care of individuals with complex social needs, such as dually eligible individuals (those eligible for Medicare and Medicaid) and adults who are newly eligible for Medicaid coverage.
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Boutwell et al. (2016) conducted an observational in Hospital discharge (n=1,546). Social work-based transitional care intervention was evaluated on All-cause 30-day readmission rates (20% relative reduction). A social work-based transitional care intervention reduced all-cause 30-day readmissions by 20% relatively (4.5% absolute reduction) among Medicare fee-for-service beneficiaries.
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