Care Transitions Program for High-Risk Frail Older Adults is Most Beneficial for Patients with Cognitive Impairment

Bjoerg (Bjorg) Thorsteinsdottir, Stephanie M. Peterson, James M Naessens, Rozalina McCoy, Gregory J. Hanson, LaTonya Hickson, Christina Yy Chen, Parvez A. Rahman, Nilay D Shah, Lynn Borkenhagen, Anupam Chandra, Rachel Havyer, Aaron Leppin, Paul Y Takahashi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)329-335
Number of pages7
JournalJournal of hospital medicine
Volume14
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Frail Elderly
Patient Transfer
Primary Health Care
Hospitalization
Independent Living
Polypharmacy
House Calls
Program Evaluation
Cognitive Dysfunction
Hospital Emergency Service
Comorbidity
Logistic Models
Demography
Delivery of Health Care
Health

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Care Transitions Program for High-Risk Frail Older Adults is Most Beneficial for Patients with Cognitive Impairment. / Thorsteinsdottir, Bjoerg (Bjorg); Peterson, Stephanie M.; Naessens, James M; McCoy, Rozalina; Hanson, Gregory J.; Hickson, LaTonya; Chen, Christina Yy; Rahman, Parvez A.; Shah, Nilay D; Borkenhagen, Lynn; Chandra, Anupam; Havyer, Rachel; Leppin, Aaron; Takahashi, Paul Y.

In: Journal of hospital medicine, Vol. 14, No. 6, 01.06.2019, p. 329-335.

Research output: Contribution to journalArticle

Thorsteinsdottir, Bjoerg (Bjorg) ; Peterson, Stephanie M. ; Naessens, James M ; McCoy, Rozalina ; Hanson, Gregory J. ; Hickson, LaTonya ; Chen, Christina Yy ; Rahman, Parvez A. ; Shah, Nilay D ; Borkenhagen, Lynn ; Chandra, Anupam ; Havyer, Rachel ; Leppin, Aaron ; Takahashi, Paul Y. / Care Transitions Program for High-Risk Frail Older Adults is Most Beneficial for Patients with Cognitive Impairment. In: Journal of hospital medicine. 2019 ; Vol. 14, No. 6. pp. 329-335.
@article{93d81ccec5264b85ade83b91893401f8,
title = "Care Transitions Program for High-Risk Frail Older Adults is Most Beneficial for Patients with Cognitive Impairment",
abstract = "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.",
author = "Thorsteinsdottir, {Bjoerg (Bjorg)} and Peterson, {Stephanie M.} and Naessens, {James M} and Rozalina McCoy and Hanson, {Gregory J.} and LaTonya Hickson and Chen, {Christina Yy} and Rahman, {Parvez A.} and Shah, {Nilay D} and Lynn Borkenhagen and Anupam Chandra and Rachel Havyer and Aaron Leppin and Takahashi, {Paul Y}",
year = "2019",
month = "6",
day = "1",
doi = "10.12788/jhm.3112",
language = "English (US)",
volume = "14",
pages = "329--335",
journal = "Journal of Hospital Medicine",
issn = "1553-5592",
number = "6",

}

TY - JOUR

T1 - Care Transitions Program for High-Risk Frail Older Adults is Most Beneficial for Patients with Cognitive Impairment

AU - Thorsteinsdottir, Bjoerg (Bjorg)

AU - Peterson, Stephanie M.

AU - Naessens, James M

AU - McCoy, Rozalina

AU - Hanson, Gregory J.

AU - Hickson, LaTonya

AU - Chen, Christina Yy

AU - Rahman, Parvez A.

AU - Shah, Nilay D

AU - Borkenhagen, Lynn

AU - Chandra, Anupam

AU - Havyer, Rachel

AU - Leppin, Aaron

AU - Takahashi, Paul Y

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85067087503&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067087503&partnerID=8YFLogxK

U2 - 10.12788/jhm.3112

DO - 10.12788/jhm.3112

M3 - Article

VL - 14

SP - 329

EP - 335

JO - Journal of Hospital Medicine

JF - Journal of Hospital Medicine

SN - 1553-5592

IS - 6

ER -