Research Activities, September 2013
Some transitional care interventions reduce 30-day readmissions and emergency department visits
Patient Safety and Quality
More than 20 percent of medical patients sustain a preventable adverse event (AE) within 3 weeks of hospital discharge. In an effort to reduce 30-day readmissions, hospitals are implementing strategies to prevent adverse outcomes after discharge.
A team of researchers from the University of California at San Francisco conducted a systematic review of the effectiveness of hospital-initiated care transition interventions to reduce AEs, emergency department (ED) visits, and readmission after discharge in general medical patients. They identified 15 studies showing that interventions successfully reduced readmission or ED visit rates after discharge. Eight of these studies showed that interventions reduced 30-day readmission rates.
Because few studies specifically addressed the problem of postdischarge AEs, there were no firm conclusions regarding effective strategies in this area. Typically, a transitional care strategy consists of one or more interventions initiated before hospital discharge with the aim of ensuring the safe and effective transition of patients from the acute care setting to home. Nearly all of the 15 studies used a bridging intervention (incorporating both predischarge and postdischarge interventions), and 10 of the 15 used a dedicated transition provider who contacted patients before and after discharge.
The most commonly used interventions included patient engagement, ranging from general patient education to more specific instruction on symptom management and medication counseling. Other interventions included postdischarge outreach to patients by telephone and/or home visit. One of the strategies used by some hospitals, the Care Transitions Intervention, has been successfully implemented and evaluated in multiple patient populations and health care systems. A similar intervention, Project RED (Re-Engineered Discharge), has been implemented in a safety net system. Although these strategies are relatively intensive and probably require considerable resources, information on the cost of transitional care strategies was lacking.
The researchers concluded that, although hospitals are being penalized for excessive readmission rates, the strategies that an individual hospital can implement to improve transitional care remain largely undefined. This study was supported by AHRQ (Contract No. 290-07-10062).
See "Hospital-initiated transitional care interventions as a patient safety strategy," by Stephanie Rennke, M.D., Oanh K. Nguyen, M.D., Marwa H. Shoeb, M.D., and others in the March 5, 2013, Annals of Internal Medicine 158(5) Part 2, pp. 433-440.