Two articles published in Archives of Internal Medicine found that transition care programs aimed at hospitalized seniors resulted in a significantly lower rate of hospital readmissions. The program helps elderly patients cope with leaving hospital.

The authors wrote:

“In the United States, 30-day all-cause readmission rates for patients 65 years or older generally range from 20 percent to 25 percent, depending on clinical condition and geographic region, indicating much room for improvement. Interventions addressing patient- and systems-level factors show promise for reducing hospital readmissions.”

First Article – Rachel Voss, M.P.H., of Quality Partners of Rhode Island, Providence, and team set out to determine how effective the Care Transitions Intervention randomized controlled trial was in reducing the rate of hospital readmissions. The program lasted 30 days and included a hospital visit by a coach, one home visit and two telephone calls to the patient.

1,042 patients were recruited at six Rhode Island acute care hospitals. They were randomly selected into three groups:

  • The Intervention Group
  • The Internal Control Group – they were offered the program but turned it down, or did not complete the home visit.
  • The External Control Group – they were not offered the program, even though they were eligible for it, according to study criteria.

The chances of being rehospitalized within 30 days of being discharged were:

  • 12.8% in the Intervention Group
  • 18.6% in the Internal Control Group
  • 20% in the External Control Group

The researchers concluded:

“..the Care Transitions Intervention appears to be effective in this real-world implementation. This finding underscores the opportunity to improve health outcomes beginning at the time of discharge in open health care settings.”

Second Article – Brett D. Stauffer, M.D., M.H.S., of the Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, gathered data from an advanced practice nurse-led transitional care program for elderly patients with heart failure. They were discharged from Baylor Medical Center Garland from mid 2009 to mid 2010.

The program involved a visit before discharge by the advanced practice nurse, followed by eight or more visits to the patient’s home after being discharged.

Stauffer wanted to determine what impact the intervention program might have at 30 days from discharge on the all-cause readmission rate. Data was also gathered on each patient’s length of stay, and the 60-day direct costs for Baylor Health Care System. This was compared to Baylor Health Care System’s costs at other hospitals.

Of the 140 eligible Medicare patients, 56 were enrolled into the study. The intervention program lowered the hospital readmission rate (within 30 days) by 48%. However, it had virtually no effect on the total 60-day direct costs for the center when compared to other hospitals.

The author concluded:

“Preliminary results suggest that transitional care programs reduce 30-day readmission rates for patients with heart failure,” the authors conclude. “This underscores the potential of the intervention to be effective in a real-world setting, but payment reform may be required for the intervention to be financially sustainable by hospitals.”

Mitchell H. Katz, M.D., of the Los Angeles County Department of Health Services, wrote:

“Decreasing hospital readmissions offers the hope of improving care while simultaneously reducing health care costs. It is therefore comforting to read in this issue of the “Archives” about two successful real-world translations of interventions shown to be effective in reducing hospitalizations in RCTs.

Although it is pleasing to see the results of the prior interventions extended, other aspects of these real-world trials are sobering. The cost-analysis by Stauffer et al points to a widespread problem in American medicine. Reimbursements are generally linked to episodes of care: visits, hospitalizations, treatments and procedures. Reimbursements are rarely provided for preventing negative outcomes.”

Dr. Katz concludes concluded:

“We need to pay for quality not quantity, for preventing illness not just treating it. Global payments with quality incentives are needed to improve America’s health care system and reduce its cost.”

Arch Intern Med. 2011;171[14]:1232-1237; 171[14]:1238-1243.

Written by Christian Nordqvist