A Reengineered Hospital Discharge Program to Decrease Rehospitalization A Randomized Trial

作者：Jack Brian W^*; Chetty Veerappa K; Anthony David; Greenwald Jeffrey L; Sanchez Gail M; Johnson Anna E; Forsythe Shaula R; O'Donnell Julie K; Paasche Orlow Michael K; Manasseh Christopher; Martin Stephen; Culpepper Larry

来源：Annals of Internal Medicine, 2009, 150(3): 178-+.

Background: Emergency department visits and rehospitalization are common after hospital discharge.
Objective: To test the effects of an intervention designed to minimize hospital utilization after discharge.
Design: 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.
Setting: General medical service at an urban, academic, safety-net hospital.
Patients: 749 English-speaking hospitalized adults (mean age, 49.9 years).
Intervention: 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.
Measurements: 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.
Results: 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.
Limitation: This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report.
Conclusion: A package of discharge services reduced hospital utilization within 30 days of discharge.

• 出版日期2009-2-3