TY - JOUR
T1 - Care transitions program for high-risk frail older adults is most beneficial for patients with cognitive impairment
AU - Thorsteinsdottir, Bjorg
AU - Peterson, Stephanie M.
AU - Naessens, James M.
AU - McCoy, Rozalina G.
AU - Hanson, Gregory J.
AU - Hickson, Latonya J.
AU - Chen, Christina Y.Y.
AU - Rahman, Parvez A.
AU - Shah, Nilay D.
AU - Borkenhagen, Lynn
AU - Chandra, Anupam
AU - Havyer, Rachel
AU - Leppin, Aaron
AU - Takahashi, Paul Y.
N1 - Funding Information:
Funding: This publication was supported by the Mayo Clinic, Robert D and Patricia E. Center for the Science of Health Care Delivery (B.T., R.H., R.G.M, L.J.H), by the Extramural Grant Program by Satellite Healthcare, a not-for-profit renal care provider (L.J.H., B.T.), and by the National Institute of Health (NIH) National Institute Of Diabetes And Digestive And Kidney Diseases grant K23 DK109134 (L.J.H.) K23DK114497 (RGM) and National Institute on Aging grant K23 AG051679 (B.T.). Additional support was provided by the National Center for Advancing Translational Sciences grant UL1 TR000135. Study contents are the sole responsibility of the authors and do not necessarily represent the official views of NIH.
Publisher Copyright:
© 2019 Society of Hospital Medicine.
PY - 2019/6
Y1 - 2019/6
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.
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U2 - 10.12788/jhm.3112
DO - 10.12788/jhm.3112
M3 - Article
C2 - 30794142
AN - SCOPUS:85067087503
VL - 14
SP - 329
EP - 335
JO - Journal of Hospital Medicine
JF - Journal of Hospital Medicine
SN - 1553-5606
IS - 6
ER -