Intensive Interventions Reduce Readmissions Globally

Marcia Frellick

September 08, 2014

High-intensity interventions, including care coordination by a nurse, a home visit within 3 days of discharge, and coordination between hospitals and primary care, reduced readmission rates between 5% and 13% up to 1 year after discharge for chronically ill patients, according to study findings published in the September issue of Health Affairs.

Only high-intensity interventions reduced readmission rates in the short term (30 days or fewer after discharge), whereas standard transitional care procedures targeted toward those at high risk for poor outcomes were effective for both the intermediate term (31 - 180 days after discharge) and long term (181 - 365 days). Standard transitional care procedures included a comprehensive patient assessment at the time of hospital admission, self-management education during admission, involving the patient’s caregivers in transitional care, and care coordination by a nurse.

Kim J. Verhaegh, a PhD student in the Department of Internal Medicine and the Department of Geriatrics at the Amsterdam Medical Centre in the Netherlands, and colleagues examined 26 randomized controlled trials in PubMed MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature published between January 1, 1980, and May 29, 2013.

They excluded studies that focused on rehabilitation after discharge or those involving pediatric patients and patients with mental illnesses, as factors contributing to those readmissions may differ from those for adults with chronic conditions.

When high-intensity interventions were used, the absolute risk reduction was 5% for short-term, 7% for intermediate-term, and 13% for long-term readmissions. When standard transitional care measures were used, the absolute risk reduction was 5% for intermediate-term and 13% for long-term readmissions, but there was no reduction in short-term readmissions.

High-intensity interventions in the first month may be necessary because in the first days after discharge many people experience fatigue, memory problems, malnutrition, and muscle weakness, which may require immediate intervention such as a home visit by a nurse within 3 days. If a nurse also performs medication reconciliation, the number of adverse drug events can be reduced, the authors found.

"To prevent intermediate- and long-term readmissions, care coordination by a nurse could be more important," the authors write. Transitional care was most effective among people older than 60 years and among those admitted to general internal medicine units, but the authors found no differences in effectiveness among countries.

They conclude that countries with aging, chronically ill patients should consider intensive interventions to prevent costly readmissions and call for more studies to examine cost-effectiveness of the interventions.

They note that in the United States, almost 20% of patients discharged from a hospital are readmitted within 30 days, at a cost to the system of between $12 billion and $44 billion per year.

Provisions of the Affordable Care Act include penalties and reductions in reimbursement for hospitals with readmission rates higher than the national average for heart failure, acute myocardial infarction, and pneumonia. It is likely that penalties and the number of diagnoses will both increase over the next few years.

The authors have disclosed no relevant financial relationships.

Health Aff. 2014;33:1531-1539. Abstract

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