What is the clinical evidence from this study?

Study design: Other. Population: Hospitalized older adults (n=422). Intervention: Discharge planning intervention toolkit vs. Preintervention period. Primary outcome: Thirty-day readmission (OR 0.59, 95% CI 0.34-0.97).

What does this research mean for the field?

A multi-component discharge planning intervention toolkit for hospitalized older adults significantly improves the quality of care transitions and reduces 30-day readmission rates and early returns to the emergency department. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 18, 2009

A Quality Improvement Intervention to Facilitate the Transition of Older Adults from Three Hospitals Back to Their Homes

Key Result

A discharge planning intervention toolkit for hospitalized older adults reduced 30-day readmission rates from 22% to 14% (OR 0.59; 95% CI 0.34-0.97).

Structured PICO

Does a discharge planning intervention toolkit reduce 30-day readmissions and emergency department returns in hospitalized patients aged 65 and older?

Population

422 patients aged 65 and older admitted to the hospitalist services at general medicine wards across three hospitals (237 in preintervention period, 185 in intervention period).

Intervention

Discharge planning intervention toolkit consisting of five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist-physician collaborative medication reconciliation, and predischarge planning appointments.

Comparator

Preintervention period (standard care).

Outcome

Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge.hard clinical

A structured discharge planning intervention toolkit significantly reduced 30-day readmissions and early emergency department returns among older adults hospitalized on general medicine wards.

Main Result

Effect estimate: OR 0.59 (95% CI 0.34-0.97)

Absolute Event Rate: 14% vs 22%

Abstract

OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention. DESIGN: Quasi-experimental pre-post study design. SETTING: General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital. PARTICIPANTS: All patients aged 65 and older admitted to the hospitalist services. INTERVENTION: The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist-physician collaborative medication reconciliation, and predischarge planning appointments. MEASUREMENTS: Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge. Odds ratios were determined, and site effects were examined accordig to interaction terms and Breslow Day statistics. RESULTS: Two hundred thirty-seven patients were followed during the preintervention period, and 185 were exposed to the intervention. Patients characteristics were similar across the two time periods. The proportion of patients with high-quality transitions home, measured according to Coleman's Care Transition Measures, increased from 68% to 89% (odds ratio (OR)=3.49, 95% confidence interval (CI)=2.06-5.92). Return to the emergency department within 3 days of discharge was lower in the intervention period (10% vs 3%, OR=0.25, 95% CI=0.10-0.62). At 30 days, there was a lower rate of readmission (22% vs 14%, OR=0.59, 95% CI=0.34-0.97) and fewer visits to the emergency department (21% vs 14%, OR=0.61, 95% CI=0.36-1.03) (P=.06). CONCLUSION: When hospitalized elderly patients are treated with consideration of their specific needs, healthcare outcomes can be improved.

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