A Multicomponent Intervention to Reduce Readmissions Among People With HIV

Abstract

Background:Hospital readmissions are common, costly, and potentially preventable, including among people with HIV (PWH). We present the results of an evaluation of a multicomponent intervention aimed at reducing 30-day readmissions among PWH.Methods:Demographic, socioeconomic, and clinical variables were collected from the electronic health records of PWH or those with cellulitis (control group) hospitalized at an urban safety-net hospital before and after (from September 2012 to December 2016) the implementation of a multidisciplinary HIV transitional care team. After October 2014, hospitalized PWH could receive a medical HIV consultation ± a transitional care nurse intervention. The primary outcome was readmission to any hospital within 30 days of discharge. Multivariate logistic regression and propensity score analyses were conducted to compare readmissions before and after intervention implementation in PWH and people with cellulitis.Results:Overall, among PWH, 329 of the 2049 (16.1%) readmissions occurred before and 329 of the 2023 (16.3%) occurred after the transitional care team intervention. After including clinical and social predictors, the adjusted odds ratio of 30-day readmissions for postintervention for PWH was 0.81 (95% confidence interval: 0.66 to 0.99, P= 0.04), whereas little reduction was identified for those with cellulitis (adjusted odds ratio 0.91 (95% confidence interval: 0.81 to 1.02, P= 0.10). A dose–response effect was not observed for receipt of different HIV intervention components.Conclusions:A multicomponent intervention reduced the adjusted risk of 30-day readmissions in PWH, although no dose–response effect was detected. Additional efforts are needed to reduce overall hospitalizations and readmissions among PWH including increasing HIV prevention, early diagnosis and engagement in care, and expanding the availability and spectrum of transitional care services.

Effects of a hospital discharge clinic among people with HIV: Lack of early follow‐up is associated with 30‐day hospital readmission and decreased retention in care

“…The benefit of early follow-up has been welldocumented in studies of clinical outcomes, where outpatient appointments, particularly for patients with severe illness [11][12][13], have been shown to reduce hospital readmissions [8][9][10]. Several studies have shown that this benefit is especially important for those at higher risk of readmission, whereas decreased benefit is seen when implementing programmes universally or as part of standard primary care [18].…”

“…Nijhawan et al analysed inpatient admissions over 2 years and found that patients who received formal HIV consult services from a multidisciplinary HIV service had a higher rate of engagement in care and virological suppression within 6 months following discharge [9]. A study from the same group also found that interventions 'targeting medical and sociobehavioral contributors to hospitalization' were associated with a reduction in 30-day readmissions [10]. These examples notwithstanding, specific strategies to improve patient engagement and retention following hospital discharge require further investigation.…”