Healthways Center for Health Research, Franklin, Tennessee 37067, USA.
Popul Health Manag. 2011 Feb;14(1):27-32. doi: 10.1089/pop.2009.0076. Epub 2010 Nov 19.
Abstract Recurrent hospitalizations are responsible for considerable health care spending, although prior studies have shown that a substantial proportion of readmissions are preventable through effective discharge planning and patient follow-up after the initial hospital visit. This retrospective cohort study was undertaken to determine whether telephonic outreach to ensure patient understanding of and adherence to discharge orders following a hospitalization is effective at reducing hospital readmissions within 30 days after discharge. Claims data were analyzed from 30,272 members of a commercial health plan who were discharged from a hospital in 2008 to determine the impact of telephonic intervention on the reduction of 30-day readmissions. Members who received a telephone call within 14 days of discharge and were not readmitted prior to that call comprised the intervention group; all other members formed the comparison group. Multiple logistic regression was used to determine the impact of the intervention on 30-day readmissions, after adjusting for covariates. Results demonstrated that older age, male sex, and increased initial hospitalization length of stay were associated with an increased likelihood of readmission (P < 0.001). Receipt of a discharge call was associated with reduced rates of readmission; intervention group members were 23.1% less likely than the comparison group to be readmitted within 30 days of hospital discharge (P = 0.043). These findings indicate that timely discharge follow-up by telephone to supplement standard care is effective at reducing near-term hospital readmissions and, thus, provides a means of reducing costs for health plans and their members.
尽管先前的研究表明,通过有效的出院计划和患者在初次住院后的随访,可以预防很大一部分再入院,但反复住院仍是医疗保健支出的主要原因。本回顾性队列研究旨在确定在出院后通过电话联系以确保患者了解并遵守出院医嘱是否能有效降低 30 天内的再入院率。对 2008 年从医院出院的某商业健康计划的 30272 名成员的理赔数据进行了分析,以确定电话干预对降低 30 天再入院率的影响。在该电话呼叫之前的 14 天内接到电话呼叫且在此之前未被再次入院的成员被归入干预组;所有其他成员被归入对照组。使用多变量逻辑回归来确定干预措施对 30 天再入院率的影响,同时调整了协变量。结果表明,年龄较大、男性和初始住院时间延长与再入院的可能性增加相关(P < 0.001)。接到出院电话与再入院率降低有关;与对照组相比,干预组成员在出院后 30 天内再次入院的可能性降低了 23.1%(P = 0.043)。这些发现表明,及时通过电话进行出院后随访以补充标准护理可有效降低近期医院再入院率,从而为健康计划及其成员降低成本提供了一种手段。