Effect of the Hospital Elder Life Program on Risk of 30‐Day Readmission

Abstract

Objectives To compare rates of 30‐day readmission between hospital units with a Hospital Elder Life Program (HELP) and control units without HELP. Design Retrospective cohort study. Setting The study took place from July 1, 2013, to June 30, 2014, at the University of Pittsburgh Medical Center Shadyside, a 520‐bed community teaching hospital that has used HELP since 2002. Eight medical and surgical units with HELP were compared with 10 medical and surgical units without HELP. Participants During the study period, HELP units, had 4,794 patients aged 70 and older, and usual care units had 2,834. Intervention HELP is a multifactorial, multidisciplinary program that provides targeted interventions for delirium risk factors in at‐risk individuals in collaboration with bedside staff. Measurements Mixed‐effects Poisson regression models were used to estimate the adjusted incident risk ratio for 30‐day readmission between HELP and usual care units for the overall cohort and for the subgroup of individuals discharged home, with or without services. Results Patients on HELP units were more likely than those in usual care units to be older, female, and black and had an unadjusted readmission rate of 16.9%, versus 18.9% for patients on control units. The adjusted risk of readmission was 0.83 (95% confidence interval (CI) = 0.73–0.94, P = .003) for HELP unit patients overall and 0.74 (95% CI = 0.63–0.87, P < .001) for HELP unit patients discharged to home with or without services. Conclusion The HELP program is associated with lower risk of 30‐day hospital readmission overall and for the subgroup of individuals discharged to home. Prospective studies are needed to confirm these observations.

Hospital Elder Life Program: Systematic Review and Meta-analysis of Effectiveness

“…A total of 14 studies were included in the meta-analysis 10,17–29 and an additional 30 were included as cost-savings studies, methodological papers, and qualitative studies. 9,11–15,27,29–51 A flow chart of identification, screening, review, and selection of studies is presented in Figure 1. The meta-analyses presented in Figures 2 and 3 categorized studies as RMTs and non-RMTs.…”

Predictive factors of a prolonged length of stay in a community Nursing‐Led unit: A retrospective cohort study

“…Patients were especially affected by diabetes mellitus and hypertensive heart disease (11.6%), two medical conditions included among the most common noncommunicable diseases by the World Health Organisation (Habib & Saha, 2010). Nonetheless, a minor to moderate severity of illness was found in almost all patients according to the APR‐DRGs, thus suggesting that the complexity of medical condition for the study population was lower than for those generally found in hospitalised patients (Pilotto et al., 2004; Rubin et al., 2018).…”

“…Organisation (Habib & Saha, 2010). Nonetheless, a minor to moderate severity of illness was found in almost all patients according to the APR-DRGs, thus suggesting that the complexity of medical condition for the study population was lower than for those generally found in hospitalised patients (Pilotto et al, 2004;Rubin et al, 2018).…”

Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

“…Fifth, our attempts to enroll a broad‐based high‐risk patient population may have limited our ability to provide specialized expertise on specific high‐risk conditions. Programs that focus on one condition, such as chronic pulmonary disease and delirium, have been shown to be effective in reducing readmissions . Thus, for some conditions, condition‐specific programs may be more effective than a program targeted to a broader group of hospitalized high‐risk geriatric patients.…”

“…Programs that focus on one condition, such as chronic pulmonary disease and delirium, have been shown to be effective in reducing readmissions. 43,44 Thus, for some conditions, condition-specific programs may be more effective than a program targeted to a broader group of hospitalized high-risk geriatric patients. Disease-specific programs may not, however, be optimal in the SNF setting because of the multiple and nonspecific nature of acute changes in condition that result in hospital transfers.…”