Key result
Cognitive impairment is unexpectedly linked to fewer 30-day readmissions in older care transitions patients.
Why the study?
The components of successful home-based care transitions programs and patient characteristics predictive of reduced 30-day readmissions in high-risk older adults were unclear.
Cohort (n=315)
No
In high-risk frail older adults enrolled in a care transitions program, patients with cognitive impairment and polypharmacy derived the most benefit, as evidenced by lower 30-day readmission rates.
Answers are grounded in this paper and cite their sources.
May identify cognitively impaired patients as high responders to care transitions; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Although posthospitalization care transitions programs (CTP) are highly diverse, their overall program thoroughness is most predictive of their success. OBJECTIVE: To identify components of a successful homebased CTP and patient characteristics that are most predictive of reduced 30-day readmissions. DESIGN: Retrospective cohort. PATIENTS: A total of 315 community-dwelling, hospitalized, older adults (≥60 years) at high risk for readmission (Elder Risk Assessment score ≥16), discharged home over the period of January 1, 2011 to June 30, 2013. SETTING: Midwest primary care practice in an integrated health system. INTERVENTION: Enrollment in a CTP during acute hospitalization. MEASUREMENTS: The primary outcome was all-cause readmission within 30 days of the first CTP evaluation. Logistic regression was used to examine independent variables, including patient demographics, comorbidities, number of medications, completion, and timing of program fidelity measures, and prior utilization of healthcare. RESULTS: The overall 30-day readmission rate was 17.1%. The intensity of follow-up varied among patients, with 17.1% and 50.8% of the patients requiring one and ≥3 home visits, respectively, within 30 days. More than half (54.6%) required visits beyond 30 days. Compared with patients who were not readmitted, readmitted patients were less likely to exhibit cognitive impairment (29.6% vs 46.0%; P = .03) and were more likely to have high medication use (59.3% vs 44.4%; P = .047), more emergency department (ED; 0.8 vs 0.4; P = .03) and primary care visits (4.0 vs 3.0; P = .018), and longer cumulative time in the hospital (4.6 vs 2.5 days; P = .03) within 180 days of the index hospitalization. Multivariable analysis indicated that only cognitive impairment and previous ED visits were important predictors of readmission. CONCLUSIONS: No single CTP component reliably predicted reduced readmission risk. Patients with cognitive impairment and polypharmacy derived the most benefit from the program.
No takes yet. Share an insight, caveat, or question.
Thorsteinsdottir et al. (2019) conducted a cohort in High-risk frail older adults (n=315). Care Transitions Program was evaluated on All-cause readmission within 30 days. In a Care Transitions Program for high-risk older adults, readmitted patients were less likely to have cognitive impairment.
Synapse has enriched 10 related papers. Consider them for comparative context: