Effects of a Multimodal Transitional Care Intervention in Patients at High Risk of Readmission

Author:

Donzé Jacques1234,John Gregor156,Genné Daniel7,Mancinetti Marco89,Gouveia Alexandre10,Méan Marie11,Bütikofer Lukas12,Aujesky Drahomir13,Schnipper Jeffrey4

Affiliation:

1. Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland

2. Division of Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland

3. Division of Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland

4. Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

5. Department of Internal Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland

6. Geneva University, Geneva, Switzerland

7. Department of Internal Medicine, Bienne Hospital Center, Bienne, Switzerland

8. Department of Internal Medicine, Hôpital cantonal de Fribourg, Villars-sur-Glâne, Switzerland

9. Medical Education Unit, University of Fribourg, Switzerland

10. Department of Ambulatory Care, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland

11. Division of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland

12. Clinical Trials Unit, University of Bern, Bern, Switzerland

13. Department of Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland

Abstract

ImportanceHospital readmissions are frequent, costly, and sometimes preventable. Although these issues have been well publicized and incentives to reduce them introduced, the best interventions for reducing readmissions remain unclear.ObjectivesTo evaluate the effects of a multimodal transitional care intervention targeting patients at high risk of hospital readmission on the composite outcome of 30-day unplanned readmission or death.Design, Setting, and ParticipantsA single-blinded, multicenter randomized clinical trial was conducted from April 2018 to January 2020, with a 30-day follow-up in 4 medium-to-large–sized teaching hospitals in Switzerland. Participants were consecutive patients discharged from general internal medicine wards and at higher risk of unplanned readmission based on their simplified HOSPITAL score (≥4 points). Data were analyzed between April and September 2022.InterventionsThe intervention group underwent systematic medication reconciliation, a 15-minute patient education session with teach-back, a planned first follow-up visit with their primary care physician, and postdischarge follow-up telephone calls from the study team at 3 and 14 days. The control group received usual care from their hospitalist, plus a 1-page standard study information sheet.Main Outcomes and MeasuresThirty-day postdischarge unplanned readmission or death.ResultsA total of 1386 patients were included with a mean (SD) age of 72 (14) years; 712 (51%) were male. The composite outcome of 30-day unplanned readmission or death was 21% (95% CI, 18% to 24%) in the intervention group and 19% (95% CI, 17% to 22%) in the control group. The intention-to-treat analysis risk difference was 1.7% (95% CI, −2.5% to 5.9%; P = .44). There was no evidence of any intervention effects on time to unplanned readmission or death, postdischarge health care use, patient satisfaction with the quality of their care transition, or readmission costs.Conclusions and RelevanceIn this randomized clinical trial, use of a standardized multimodal care transition intervention targeting higher-risk patients did not significantly decrease the risks of 30-day postdischarge unplanned readmission or death; it demonstrated the difficulties in preventing hospital readmissions, even when multimodal interventions specifically target higher-risk patients.Trial RegistrationClinicalTrials.gov Identifier: NCT03496896

Publisher

American Medical Association (AMA)

Subject

Internal Medicine

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