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Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults

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Finlayson, K, Chang, AM, Courtney, MD, Edwards, HE, Parker, AW, Hamilton, K, Pham, TDX and O'Brien, J ORCID: 0000-0002-6504-8422 2018 , 'Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults' , Bmc Health Services Research, vol. 18 , pp. 1-9 , doi: 10.1186/s12913-018-3771-9.

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Abstract

Background: Acute hospital services account for the largest proportion of health care system budgets, and olderadults are the most frequent users. As a result, older people who have been recently discharged from hospital maybe at greater risk of readmission. This study aims to evaluate the comparative effectiveness of transitional careinterventions on unplanned hospital readmissions within 28 days, 12 weeks and 24 weeks following hospitaldischarge.Method: The present study was a randomised controlled trial (ACTRN12608000202369). The trial involved 222 participantswho were recruited from medical wards in two metropolitan hospitals in Australia. Participants were eligible for inclusion ifthey were aged 65 years and over, admitted with a medical diagnosis and had at least one risk factor for readmission.Participants were randomised to one of four groups: standard care, exercise program only, Nurse Home visit and Telephonefollow-up (N-HaT), or Exercise program and Nurse Home visit and Telephone follow-up (ExN-HaT). Socio-demographics,health and functional ability were assessed at baseline, 28 days, 12 weeks and 24 weeks. The primary outcome measure wasunplanned hospital readmission which was defined as any hospital admission for an unforeseen or unplanned cause.Results: Participants in the ExN-HaT or the N-HaT groups were 3.6 times and 2.6 times respectively significantly less likely tohave an unplanned readmission 28 days following discharge (ExN-HaT group HR 0.28, 95% CI 0.09–0.87, p = 0.029; N-HaTgroup HR 0.38, 95% CI 0.13–1.07, p = 0.067). Participants in the ExN-HaT or the N-HaT groups were 2.13 and 2.63 timesrespectively less likely to have an unplanned readmission in the 12 weeks after discharge (ExN-HaT group HR 0.47, 95% CI 0.23–0.97, p = 0.014; N-HaT group HR 0.38, 95% CI 0.18–0.82, p = 0.040). At 24 weeks after discharge, there were no significantdifferences between groups.Conclusion: Multifaceted transitional care interventions across hospital and community settings are beneficial, with lowerhospital readmission rates observed in those receiving more transitional intervention components, although only in first12 weeks.

Item Type: Article
Authors/Creators:Finlayson, K and Chang, AM and Courtney, MD and Edwards, HE and Parker, AW and Hamilton, K and Pham, TDX and O'Brien, J
Keywords: Hospital readmission Older adults Randomised controlled trial transitional care
Journal or Publication Title: Bmc Health Services Research
Publisher: Biomed Central Ltd
ISSN: 1472-6963
DOI / ID Number: 10.1186/s12913-018-3771-9
Copyright Information:

Copyright 2018 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

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