30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study

Paul Y Takahashi,1 Lindsey R Haas,2 Stephanie M Quigg,1 Ivana T Croghan,1 James M Naessens,2 Nilay D Shah,2 Gregory J Hanson11Division of Primary Care Internal Medicine, Department of Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USAPurpose: Patients leaving the hosp...

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Autores principales:	Takahashi PY, Haas LR, Quigg SM, Croghan IT, Naessens JM, Shah ND, Hanson GJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	case management cohort study frailty geriatrics Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/2d35014f189943df805cc7d99077bc17
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spelling	oai:doaj.org-article:2d35014f189943df805cc7d99077bc172021-12-02T05:02:55Z30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study1178-1998https://doaj.org/article/2d35014f189943df805cc7d99077bc172013-06-01T00:00:00Zhttps://www.dovepress.com/30-day-hospital-readmission-of-older-adults-using-care-transitions-aft-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Paul Y Takahashi,1 Lindsey R Haas,2 Stephanie M Quigg,1 Ivana T Croghan,1 James M Naessens,2 Nilay D Shah,2 Gregory J Hanson11Division of Primary Care Internal Medicine, Department of Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USAPurpose: Patients leaving the hospital are at increased risk of functional decline and hospital readmission. The Employee and Community Health service at Mayo Clinic in Rochester developed a care transition program (CTP) to provide home-based care services for medically complex patients. The study objective was to determine the relationship between CTP use, 30-day hospital readmission, and Emergency Room (ER) visits for adults over 60 years with high Elder Risk Assessment scores.Patients and methods: This was a pilot prospective cohort study that included 20 patients that used the CTP and 20 patients discharged from the hospital without using the CTP. The medically complex study patients were drawn from the department of Employee and Community Health population between October 14, 2011 and September 27, 2012. The primary outcomes were 30-day hospital readmission or ER visit after discharge from the hospital. The secondary outcomes were within-group changes in grip strength, gait speed, and quality of life (QOL). Patients underwent two study visits, one at baseline and one at 30 days postbaseline. The primary analysis included time-to-event from baseline to rehospitalization or ER visit. Paired t-tests were used for secondary outcomes, with continuous scores.Results: Of the 40 patients enrolled, 36 completed all study visits. The 30-day hospital readmission rates for usual care patients were 10.5% compared with no readmissions for CTP patients. There were 31.6% ER visits in the UC group and 11.8% in the CTP group (P = 0.37). The secondary analysis showed some improvement in physical QOL scores (pre: 32.7; post: 39.4) for the CTP participants (P < 0.01) and no differences in gait speed or grip strength.Conclusion: Based on this pilot study of care transition, we found nonsignificant lower hospital and ER utilization rates and improved physical QOL scores for patients in the CTP group. However, the data leads us to recommend future studies with larger sample sizes (N = 250).Keywords: case management, cohort study, frailty, geriatricsTakahashi PYHaas LRQuigg SMCroghan ITNaessens JMShah NDHanson GJDove Medical Pressarticlecase managementcohort studyfrailtygeriatricsGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 8, Pp 729-736 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	case management cohort study frailty geriatrics Geriatrics RC952-954.6
spellingShingle	case management cohort study frailty geriatrics Geriatrics RC952-954.6 Takahashi PY Haas LR Quigg SM Croghan IT Naessens JM Shah ND Hanson GJ 30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study
description	Paul Y Takahashi,1 Lindsey R Haas,2 Stephanie M Quigg,1 Ivana T Croghan,1 James M Naessens,2 Nilay D Shah,2 Gregory J Hanson11Division of Primary Care Internal Medicine, Department of Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USAPurpose: Patients leaving the hospital are at increased risk of functional decline and hospital readmission. The Employee and Community Health service at Mayo Clinic in Rochester developed a care transition program (CTP) to provide home-based care services for medically complex patients. The study objective was to determine the relationship between CTP use, 30-day hospital readmission, and Emergency Room (ER) visits for adults over 60 years with high Elder Risk Assessment scores.Patients and methods: This was a pilot prospective cohort study that included 20 patients that used the CTP and 20 patients discharged from the hospital without using the CTP. The medically complex study patients were drawn from the department of Employee and Community Health population between October 14, 2011 and September 27, 2012. The primary outcomes were 30-day hospital readmission or ER visit after discharge from the hospital. The secondary outcomes were within-group changes in grip strength, gait speed, and quality of life (QOL). Patients underwent two study visits, one at baseline and one at 30 days postbaseline. The primary analysis included time-to-event from baseline to rehospitalization or ER visit. Paired t-tests were used for secondary outcomes, with continuous scores.Results: Of the 40 patients enrolled, 36 completed all study visits. The 30-day hospital readmission rates for usual care patients were 10.5% compared with no readmissions for CTP patients. There were 31.6% ER visits in the UC group and 11.8% in the CTP group (P = 0.37). The secondary analysis showed some improvement in physical QOL scores (pre: 32.7; post: 39.4) for the CTP participants (P < 0.01) and no differences in gait speed or grip strength.Conclusion: Based on this pilot study of care transition, we found nonsignificant lower hospital and ER utilization rates and improved physical QOL scores for patients in the CTP group. However, the data leads us to recommend future studies with larger sample sizes (N = 250).Keywords: case management, cohort study, frailty, geriatrics
format	article
author	Takahashi PY Haas LR Quigg SM Croghan IT Naessens JM Shah ND Hanson GJ
author_facet	Takahashi PY Haas LR Quigg SM Croghan IT Naessens JM Shah ND Hanson GJ
author_sort	Takahashi PY
title	30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study
title_short	30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study
title_full	30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study
title_fullStr	30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study
title_full_unstemmed	30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study
title_sort	30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/2d35014f189943df805cc7d99077bc17
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30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study

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