Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, USA; Center for Health Services Research, Vanderbilt University Medical Center, USA.
Department of Biostatistics & Medical Informatics, University of Wisconsin - Madison, Madison, WI, USA.
Contemp Clin Trials. 2019 Jun;81:55-61. doi: 10.1016/j.cct.2019.04.014. Epub 2019 Apr 25.
The optimal structure and intensity of interventions to reduce hospital readmission remains uncertain, due in part to lack of head-to-head comparison. To address this gap, we evaluated two forms of an evidence-based, multi-component transitional care intervention.
A quasi-experimental evaluation design compared outcomes of Transition Care Coordinator (TCC) Care to Usual Care, while controlling for sociodemographic characteristics, comorbidities, readmission risk, and administrative factors. The study was conducted between January 1, 2013 and April 30, 2015 as a quality improvement initiative. Eligible adults (N = 7038) hospitalized with pneumonia, congestive heart failure, or chronic obstructive pulmonary disease were identified for program evaluation via an electronic health record algorithm. Nurse TCCs provided either a full intervention (delivered in-hospital and by post-discharge phone call) or a partial intervention (phone call only).
A total of 762 hospitalizations with TCC Care (460 full intervention and 302 partial intervention) and 6276 with Usual Care was examined. In multivariable models, hospitalizations with TCC Care had significantly lower odds of readmission at 30 days (OR = 0.512, 95% CI 0.392 to 0.668) and 90 days (OR = 0.591, 95% CI 0.483 to 0.723). Adjusted costs were significantly lower at 30 days (difference = $3969, 95% CI $5099 to $2691) and 90 days (difference = $5684, 95% CI $7602 to $3627). The effect was similar whether patients received the full or partial intervention.
An evidence-based multi-component intervention delivered by nurse TCCs reduced 30- and 90-day readmissions and associated health care costs. Lower intensity interventions delivered by telephone after discharge may have similar effectiveness to in-hospital programs.
由于缺乏头对头比较，降低医院再入院率的最佳干预结构和强度仍不确定。为了解决这一差距，我们评估了两种基于证据的多组分过渡性护理干预措施。
一项准实验评估设计比较了过渡护理协调员（TCC）护理与常规护理的结果，同时控制了社会人口统计学特征、合并症、再入院风险和管理因素。该研究于 2013 年 1 月 1 日至 2015 年 4 月 30 日作为一项质量改进计划进行。通过电子病历算法，为计划评估确定了患有肺炎、充血性心力衰竭或慢性阻塞性肺疾病的合格成年人（N=7038）。护士 TCC 提供了完整的干预措施（在医院内提供并通过出院后的电话提供）或部分干预措施（仅电话）。
共检查了 762 例 TCC 护理（460 例全干预和 302 例部分干预）和 6276 例常规护理的住院情况。在多变量模型中，TCC 护理的住院患者在 30 天（OR=0.512，95%CI 0.392 至 0.668）和 90 天（OR=0.591，95%CI 0.483 至 0.723）的再入院率显著降低。30 天（差异=3969 美元，95%CI 5099 至 2691 美元）和 90 天（差异=5684 美元，95%CI 7602 至 3627 美元）的调整后成本显著降低。无论患者接受完整干预还是部分干预，效果都相似。
由护士 TCC 提供的基于证据的多组分干预措施降低了 30 天和 90 天的再入院率和相关医疗保健成本。出院后通过电话提供的低强度干预措施可能与住院方案具有相似的效果。
