Preventing 30-Day Hospital Readmissions

Abstract

IMPORTANCE Reducing early (<30 days) hospital readmissions is a policy priority aimed at improving health care quality. The cumulative complexity model conceptualizes patient context. It predicts that highly supportive discharge interventions will enhance patient capacity to enact burdensome self-care and avoid readmissions.OBJECTIVE To synthesize the evidence of the efficacy of interventions to reduce early hospital readmissions and identify intervention features-including their impact on treatment burden and on patients' capacity to enact postdischarge self-care-that might explain their varying effects.DATA SOURCES We searched PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Scopus (1990 until April 1, 2013), contacted experts, and reviewed bibliographies.STUDY SELECTION Randomized trials that assessed the effect of interventions on all-cause or unplanned readmissions within 30 days of discharge in adult patients hospitalized for a medical or surgical cause for more than 24 hours and discharged to home. DATA EXTRACTION AND SYNTHESISReviewer pairs extracted trial characteristics and used an activity-based coding strategy to characterize the interventions; fidelity was confirmed with authors. Blinded to trial outcomes, reviewers noted the extent to which interventions placed additional work on patients after discharge or supported their capacity for self-care in accordance with the cumulative complexity model. MAIN OUTCOMES AND MEASURESRelative risk of all-cause or unplanned readmission with or without out-of-hospital deaths at 30 days postdischarge. RESULTSIn 42 trials, the tested interventions prevented early readmissions (pooled random-effects relative risk, 0.82 [95% CI, 0.73-0.91]; P < .001; I 2 = 31%), a finding that was consistent across patient subgroups. Trials published before 2002 reported interventions that were 1.6 times more effective than those tested later (interaction P = .01). In exploratory subgroup analyses, interventions with many components (interaction P = .001), involving more individuals in care delivery (interaction P = .05), and supporting patient capacity for self-care (interaction P = .04) were 1.4, 1.3, and 1.3 times more effective than other interventions, respectively. A post hoc regression model showed incremental value in providing comprehensive, postdischarge support to patients and caregivers.CONCLUSIONS AND RELEVANCE Tested interventions are effective at reducing readmissions, but more effective interventions are complex and support patient capacity for self-care. Interventions tested more recently are less effective.

Thirty‐Day Readmission Rates, Timing, Causes, and Costs after ST‐Segment–Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010–2014

“…The timing of 30‐day readmissions highlights the importance of both early outpatient care and longitudinal surveillance strategies within 30 to 90 days following hospitalization 18. Measures focusing on supportive discharge interventions have been shown to enhance patient capacity for self‐care and have helped to avoid readmissions 19. Comprehensive programs that focus on both inpatient and outpatient interventions and utilize tools that facilitate cross‐site communication can lead to a decrease in early readmissions 20, 21.…”

Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage

“…11,12,23,34 However, given the complexity of caring for patients with SAH, the role of early follow-up (e.g., within 1 week of discharge) with a primary care physician in preventing readmission may warrant further investigation in this unique population. Recent work has also emphasized the effectiveness of complex, multifaceted strategies in reducing readmission, 18 and a combination of multiple inpatient and outpatient strategies could also be impactful in preventing rehospitalization after SAH.…”

Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program

“…6 With cumulative complexity in mind, a systematic review found that the most effective interventions for reducing 30-day readmissions in nonstroke populations were the ones that comprehensively increased patient capacity for self-care, had a higher number of intervention activities and interactions, and had ≥2 individuals involved in its delivery (relative risk, 0.63; 95% confidence interval, 0.43-0.91; P=0.02). 7 In stroke patients, a recent systematic review reported that less than half of transitional care models were successful at improving outcomes, and none actually reduced emergency department or hospital readmissions. 8 Because of the variability of stroke transitional care model interventions, Prvu Bettger et al 9 …”