Transitional care intervention program may reduce high-risk readmissions

1. This quasi-experimental study, which employed a personalized transitional care intervention on readmission rates of Medicare fee-for-service (FFS) high-risk patients, showed a small but significant decrease in readmissions rates.

2. Although this positive study showed a reduction in readmission rates, it did not achieve the goal reduction target set by the Center for Medicare & Medicaid Services (CMS) and thus it’s applicability is limited.

Evidence Rating Level: 2 (Good)

Study Rundown: Reducing hospital readmissions has been an important cost-lowering effort across the USA and Canada. However, despite numerous program efforts, readmissions rates have not been significantly lowered. This quasi-experimental study aimed to evaluate whether overall Medicare FFS readmissions were reduced through application of a personalized transitional care intervention applied to high-risk discharge patients.

Thirty-day unplanned same-hospital readmission rates of high-risk Medicare FFS patients assigned to the personalized transitional care intervention had a reduction of about ten percent relative to the control group. This represented about fifty patients who would need to receive this transitional care to prevent one readmission. Although this study showed a positive impact on reducing readmission rates in this high-risk population, it did not achieve the pre-specified goal reduction target set by the CMS (20%). Further risk stratification amongst the patients or a different form of transitional care may improve on these results in the future.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Interventions to Reduce 30-Day Rehospitalization: A Systematic Review

In-Depth [quasi-experimental]: This study took place from May 2011 to May 2014 in one urban academic medical center in New Haven, CT. The target population included discharged patients who were 64 years or older and had Medicare FFS insurance. Control patients were 54 years or older but without Medicare FFS insurance. All patients had to be discharged to home or a facility. High-risk discharges were identified using risk factors and comorbidities defined in the Society of Hospital Medicine’s Project BOOST (Better Outcomes by Optimizing Safe Transitions). The intervention of study was a transitional care program that included education, medication reconciliation, telephone follow-up calls, and community resources that were tailored to the individual needs of the patient. The outcome of interest was the 30-day unplanned same-hospital readmission rate. The CMS predetermined a target rate reduction of 20%. Statistical analysis included both a difference in differences and an interrupted time series analysis.

A total of 10 621 patients were included in this analysis, which represented 74% of discharge patients considered high-risk. The mean age of the target population was 79.7 years. The adjusted readmission rate decreased from 21.5% to 19.5% in the target population and from 21.1% to 21.0% in the control population. This represented a relative rate reduction of 9.3% and a number needed to treat to avoid one readmission of 50. The difference in differences logistic regression revealed a statistically significant decrease in odds of readmission (OR 0.90; 95%CI 0.83-0.99; p = 0.03). The interrupted time series analysis did not reveal a statistically significant decrease in readmission rate (-3.09; 95%CI -6.47 to 0.29; p = 0.07).

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