The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial.
J Hosp Med
; 16(1): 15-22, 2021 01.
Article
em En
| MEDLINE
| ID: mdl-33357325
ABSTRACT
BACKGROUND:
Transitions from hospital to the ambulatory setting are high risk for patients in terms of adverse events, poor clinical outcomes, and readmission.OBJECTIVES:
To develop, implement, and refine a multifaceted care transitions intervention and evaluate its effects on postdischarge adverse events. DESIGN, SETTING, ANDPARTICIPANTS:
Two-arm, single-blind (blinded outcomes assessor), stepped-wedge, cluster-randomized clinical trial. Participants were 1,679 adult patients who belonged to one of 17 primary care practices and were admitted to a medical or surgical service at either of two participating hospitals within a pioneer accountable care organization (ACO).INTERVENTIONS:
Multicomponent intervention in the 30 days following hospitalization, including inpatient pharmacist-led medication reconciliation, coordination of care between an inpatient "discharge advocate" and a primary care "responsible outpatient clinician," postdischarge phone calls, and postdischarge primary care visit. MAIN OUTCOMES ANDMEASURES:
The primary outcome was rate of postdischarge adverse events, as assessed by a 30-day postdischarge phone call and medical record review and adjudicated by two blinded physician reviewers. Secondary outcomes included preventable adverse events, new or worsening symptoms after discharge, and 30-day nonelective hospital readmission.RESULTS:
Among patients included in the study, 692 were assigned to usual care and 987 to the intervention. Patients in the intervention arm had a 45% relative reduction in postdischarge adverse events (18 vs 23 events per 100 patients; adjusted incidence rate ratio, 0.55; 95% CI, 0.35-0.84). Significant reductions were also seen in preventable adverse events and in new or worsening symptoms, but there was no difference in readmission rates.CONCLUSION:
A multifaceted intervention was associated with a significant reduction in postdischarge adverse events but no difference in 30-day readmission rates.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Transferência de Pacientes
/
Assistência ao Convalescente
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article