A reengineered hospital discharge program to decrease rehospitalization: A randomized trial

Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA.
Annals of internal medicine (Impact Factor: 16.1). 03/2009; 150(3):178-87.
Source: PubMed

ABSTRACT Emergency department visits and rehospitalization are common after hospital discharge.
To test the effects of an intervention designed to minimize hospital utilization after discharge.
Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card.
General medical service at an urban, academic, safety-net hospital.
749 English-speaking hospitalized adults (mean age, 49.9 years).
A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment.
Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers' follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment.
Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed.
This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report.
A package of discharge services reduced hospital utilization within 30 days of discharge.
Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute, National Institutes of Health.

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    • "Various trials have evaluated different interventions to decrease drug-related problems in the elderly after hospital discharge, ranging from followup from a dedicated pharmacist to major and costly changes to the hospital discharge processes. These interventions have had varying effects on medication adherence and postdischarge quality measures, but few cost-effective strategies have been described [18] [19]. "
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    ABSTRACT: Objectives. To evaluate the adherence rate to prescribed medications in elderly patients 24-48 hours after being discharged from the hospital. Methods. Family medicine residents visited patients over the age of 65 years at their homes one to two days after being discharged from the hospital and documented all the medications that they were taking since coming home from the hospital. The list of medications was later compared to the medications recorded in hospital discharge instructions. Results. Complete data was available for 46 participants. The average patient age was 76 years; 54.4% were women. Only three patients (6.5%) adhered completely to the discharge medication list found in the medical record. Thirty-six patients (78.2%) reported taking at least one additional prescription medication, twenty patients (43.4%) missed at least one prescription medication, twenty patients (43.4%) reported taking the wrong dose of at least one medication, and nineteen patients (41.3%) reported taking medications at an incorrect frequency. Conclusion. The vast majority of elderly patients in our study did not adhere to the medication regimen in the first two days after hospital discharge. Cost-effective improvements to hospital discharge processes are needed to improve adherence and reduce preventable posthospitalization complications.
    03/2013; 2013:901845. DOI:10.1155/2013/901845
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    • "The result of another study conducted in Jordan (Eshah et al., 2010) provides evidence of the role of health education in improving daily life through adoption of a healthier lifestyles, which would consequently have a positive impact on patients' health and help them to avoid having another cardiac event. Previous studies (Haerem et al., 2000; Baessler et al., 2001; Oterhals et al., 2006; Jack et al., 2009; Kang et al., 2010; Nawathe et al., 2010; Hacihasanog ˘ lu & Gözüm, 2011) reported that health education changed health behavior habits and improved patients' knowledge, lifestyle, satisfaction level, adherence to prescribed medications, and utilization of hospital resources, thereby decreasing healthcare expenses. Reduction in risk factor levels (evaluated by decreased blood pressure, resting heart rate, body mass index, serum lipids, and smoking) was also reported with longer follow-up periods (Baessler et al., 2001; Aldanal et al., 2008; Hacihasanog ˘ lu & Gözüm, 2011). "
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    ABSTRACT: Risk factor reduction and modification of patient lifestyle have become the focus of secondary prevention and cardiac rehabilitation programs. Considering the scarcity of resources in developing countries, nurses can potentially provide great benefit to acute coronary syndrome patients by utilizing hospital time to teach the patients how to lower their risk for recurrence and adopt healthier lifestyles after discharge. The purpose of this study was to identify the effectiveness of a predischarge education on acute coronary syndrome patients' lifestyles. Quasi-experimental pretest-post-test design was used. The patients assigned to the experimental group were offered predischarge education that stimulates lifestyle modification and adoption of a healthier lifestyle. The experimental group scored significantly higher than the control group in three lifestyle components - health responsibilities, nutrition, and interpersonal relations. In conclusion, predischarge education helps motivate acute coronary syndrome patients to adhere to a healthy lifestyle postdischarge. Therefore, nurses must be educated and prepared to be qualified health educators, and health education should continue as one of the most important daily nursing practices, thus it is invested in the preparation of acute coronary patients' discharge plan.
    Nursing and Health Sciences 01/2013; DOI:10.1111/nhs.12018 · 0.85 Impact Factor
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    • "Many of these interventions focus on reducing readmission to the hospital (Hansen, Young, Hinami, Leung, & Williams, 2011), while others seek to improve medication management, quality of life, and satisfaction (Preen et al., 2005; Schnipper et al., 2010). It is unfortunate that despite positive results from a few well-conducted studies (Coleman, Parry, Chalmers, & Min, 2006; Jack et al., 2009; Naylor et al., 1999), most care transition interventions have not proven efficacious in reducing readmission (Hansen et al., 2011). "
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    ABSTRACT: After hospital discharge, patients commonly suffer potentially avoidable adverse events and hospital readmissions. As hospitals implement interventions to improve discharge transitions, it is important to understand patients' perspectives on which intervention components are most beneficial. This study examined a sample of 125 patients randomized to the intervention arm of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease study who completed a telephone survey about the helpfulness of different components of the intervention, which included medication reconciliation, inpatient counseling, simple adherence aids, and telephone follow-up. The majority of patients indicated that it was "very helpful" to speak with a pharmacist about their medications before discharge (72.8%), particularly about how to take the medications and how to prevent and manage side effects. Receiving an illustrated medication list (69.6%) and a follow-up phone call after discharge (68.0%) were also considered very helpful. Patients with limited health literacy indicated the greatest benefit. Patients also reported feeling more comfortable speaking with their outpatient providers about their medications after receiving the intervention. In conclusion, patients-particularly those with limited health literacy-found a hospital pharmacist-based intervention to be very helpful and empowering.
    Journal of Health Communication 10/2012; 17 Suppl 3:312-24. DOI:10.1080/10810730.2012.712619 · 1.61 Impact Factor
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