RESUMO
BACKGROUND: Well-executed communication among hospital providers, patients, and receiving providers at the time of hospital discharge contributes to better health outcomes and lower overall health care costs. The Care Transitions Intervention has reduced 30-day hospital readmissions by 30% in a randomized controlled trial in an integrated health system but requires real-world testing to establish effectiveness in other settings. We hypothesized that coaching would reduce 30-day readmission rates for fee-for-service Medicare beneficiaries, even in open, urban health care delivery systems. METHODS: This was a quasi-experimental prospective cohort study. From January 1, 2009, through June 30, 2010, coaches recruited a convenience sample of fee-for-service Medicare patients in 6 Rhode Island hospitals to receive the Care Transitions Intervention. We paired coaching data with Medicare claims and enrollment data and used logistic regression to compare the odds of 30-day readmission for the intervention group vs internal and external control groups. RESULTS: Compared with individuals who did not receive any part of the intervention (20.0% readmission rate), 30-day readmissions were fewer for participants who received coaching (12.8%; odds ratio, 0.61; 95% confidence interval, 0.42-0.88). Individuals in the internal control group (declined to participate or were lost to follow-up before completing a home visit) had readmission rates similar to those of the external control group (18.6%; odds ratio, 0.94, 95% confidence interval, 0.77-1.14). CONCLUSIONS: The Care Transitions Intervention appears to be effective in this real-world implementation. This finding underscores the opportunity to improve health outcomes beginning at the time of discharge in open health care settings.
Assuntos
Continuidade da Assistência ao Paciente , Alta do Paciente/normas , Educação de Pacientes como Assunto/métodos , Readmissão do Paciente/estatística & dados numéricos , Prática Avançada de Enfermagem , Idoso , Idoso de 80 Anos ou mais , Continuidade da Assistência ao Paciente/tendências , Planos de Pagamento por Serviço Prestado , Feminino , Hospitais Comunitários/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Medicare , Pessoa de Meia-Idade , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto/normas , Educação de Pacientes como Assunto/tendências , Readmissão do Paciente/economia , Estudos Prospectivos , Rhode Island/epidemiologia , Estudos de Amostragem , Serviço Social , Estados Unidos , População Urbana/estatística & dados numéricosRESUMO
CONTEXT: Few studies on presumed consent and environmental predictors of cadaveric organ donation in Europe have been published. OBJECTIVE: To determine if a presumed consent policy and other variables can be used to predict the cadaveric organ donation rate per million population. DESIGN: Secondary analysis of published data. SETTING: Europe. PARTICIPANTS: The unit of analysis for this study is the individual country. MAIN OUTCOME MEASURE: Cadaveric organ donation rate per million population. RESULTS: Original and transformed data were subjected to ordinary least-squares regression. All 4 independent variables were significant predictors of cadaveric donation rate, including (1) having a presumed consent (opting-out) policy in practice, (2) number of transplant centers per million population, (3) percentage of the population enrolled in third-tier education, and (4) percentage of population that is Roman Catholic. CONCLUSION: Findings may be useful to academics and professionals responsible for organ procurement. Additional research is necessary for practical application of findings. Generalizing these findings beyond Europe may be problematic because of external validity constraints.
