Prompt Outpatient Care For Older Adults Discharged From The Emergency Department Reduces Recidivism

Magidson, Phillip D.; Huang, Jin; Levitan, Emily B; Westfall, Andrew O.; Sheehan, Orla C.; Roth, David L.

doi:10.5811/westjem.2020.8.47276

Cited by 9 publications

(11 citation statements)

References 30 publications

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“…The second possibility is that our target population was too broad. Some researchers 12,18,29 contend that care transition interventions may only prove effective when targeted to those at highest risk of return or experiencing care fragmentation, such as those with advanced age, medical complexity, cognitive impairment, mental health issues, low health literacy, low social support 2,6,10,19,42,47,48 . Others argue that interventions targeting patients with modifiable risk factors would be more effective than using an undifferentiated approach 11,49,50 …”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Jacobsohn

Jones

Green

et al. 2021

Academic Emergency Medicine

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Background Improving care transitions following emergency department (ED) visits may reduce post‐ED adverse events among older adults (e.g., ED revisits, decreased function). The Care Transitions Intervention (CTI) improves hospital‐to‐home transitions; however, its effectiveness at improving post‐ED outcomes is unknown. We tested the effectiveness of the CTI with community‐dwelling older adult ED patients, hypothesizing that it would reduce revisits and increase performance of self‐management behaviors during the 30 days following discharge. Methods We conducted a randomized controlled trial among patients age ≥ 60 discharged home from one of three EDs in two states. Intervention participants received a minimally modified CTI, with a home visit 24 to 72 h postdischarge and one to three phone calls over 28 days. We collected demographic, health status, and psychosocial data at the initial ED visit. Medication adherence and knowledge of red flag symptoms were assessed via phone survey. Care use and comorbidities were abstracted from medical records. We performed multivariate regressions for intention‐to‐treat and per‐protocol (PP) analyses. Results Participant characteristics (N = 1,756) were similar across groups: mean age 72.4 ± 8.6 years and 53% female. Of those randomized to the intervention, 84% completed the home visit. Overall, 12.4% of participants returned to the ED within 30 days. The CTI did not significantly affect odds of 30‐day ED revisits (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.72 to 1.30) or medication adherence (AOR = 0.89, 95% CI = 0.60 to 1.32). Participants receiving the CTI (PP) had increased odds of in‐person follow‐up with outpatient clinicians during the week following discharge (AOR = 1.24, 95% CI = 1.01 to 1.51) and recalling at least one red flag from ED discharge instructions (AOR = 1.34 95% CI = 1.05 to 1.71). Conclusions The CTI did not reduce 30‐day ED revisits but did significantly increase key care transition behaviors (outpatient follow‐up, red flag knowledge). Additional research is needed to explore if patients with different conditions benefit more from the CTI and whether decreasing ED revisits is the most appropriate outcome for all older adults.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Jacobsohn

Jones

Green

et al. 2021

Academic Emergency Medicine

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“…Additionally, the GED guidelines and accreditation standards recommend identifying older adults at risk for adverse outcomes and address follow‐up care by connecting the patient with timely outpatient services 16–19 . A previous study reported that older adults who were discharged home after an ED visit and followed‐up with primary care and subspecialty care within 30 days had lower ED revisits 20 . However, it remains unclear how to accomplish an efficient referral order process and prompt outpatient care post ED visit.…”

Section: Introductionmentioning

confidence: 99%

Association of Geriatric Emergency Department post‐discharge referral order and follow‐up with healthcare utilization

Simpson

Sergi

Malsch

et al. 2022

J American Geriatrics Society

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Background: Compared with younger adults who receive care in the emergency department (ED), older patients who are discharged home have greater risk of adverse health outcomes. Connecting older adults with outpatient care following ED discharge are among the guidelines of the Geriatric Emergency Department (GED). The objective of this study was to examine the association between referral order placed during the ED visit for older adults and post-discharge follow-up to the outcomes of 72-h ED revisit, 30-day ED revisit, and 30-day all cause and unplanned hospital admission. Methods: We conducted a retrospective cohort study. Ten accredited GEDs within one midwestern health system and all ED encounters of older adults aged 65 years and older who were discharged home from the ED between July 2019 and December 2020 were included. Predictor variables included age, sex, race, ISAR©, ED Length of Stay, post-ED referral order, and follow-up. Results: Among the older adults discharged home from the ED, 17% of older adult encounters had an outpatient referral ordered in the ED, 48.4% attended a follow-up appointment. Referrals were ordered for 69 referral order types with orthopedic, family practice, and urology referrals as the top 3. In mixedeffect regression models, compared with older adults with follow-up, those with a referral order but no follow-up had 19% higher odds of having a 30-day ED revisit (OR = 1.19; 95% CI = 1.07-1.31) and 11% higher odds of having 30-day unplanned hospital admission (OR = 1.11; 95% CI = 0.98-1.26).Conclusions: Older adults who had an outpatient referral ordered prior to ED discharge and followed up had lower odds of a 30-day ED revisit and 30-day subsequent unplanned hospital admission. However, less than half of patients with a referral order attended a follow-up appointment. Designing interventions for older adults aimed at improving follow-up after an ED visit is needed.

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“…For example, lower medication adherence has been associated with a greater risk of stroke, 3,12 while being seen by a primary care provider after an emergency department visit has been shown to reduce recurrent emergency department visits. 13 Successful TOC is particularly challenging after stroke hospitalization. Physical disability, depression and cognitive impairment affect patients' ability to follow instructions, participate in educational activities, and navigate the complex healthcare system; socioeconomic and environmental factors may considerably affect access and utilization of posthospitalization stroke care that impact successful TOC and long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors and Behaviors Related to Successful Transition of Care After Hospitalization for Ischemic Stroke

Dong

Gardener

Rundek

et al. 2023

Stroke

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BACKGROUND: Our objective is to describe adoption of the posthospitalization behaviors associated with successful transition of care and related baseline characteristics. METHODS: This study includes 550 participants in the Transition of Care Stroke Disparities Study, a prospective observational cohort derived from the Florida Stroke Registry. Participants had an ischemic stroke (2018–2021), discharged home or to rehabilitation, with modified Rankin Scale score=0–3 (44% women, 24% Black, 48% White, 26% Hispanic, 35% foreign-born). We collected baseline sociodemographic and clinical characteristics. A structured telephone interview at 30-day postdischarge evaluated outcomes including medication adherence, medical appointment attendance, outpatient therapy, exercise, diet modification, toxic habit cessation, and a calculated composite adequate transition of care measure. Multivariable analyses assessed the association of baseline characteristics with 30-day behaviors. RESULTS: At 30 days, medication adherence was achieved by 89%, medical appointments by 82%, outpatient therapy by 76%, exercise by 71%, diet modification by 68%, toxic habit cessation by 35%, and adequate transition of care measure by 67%. Successful adequate transition of care participants were more likely to be used full-time (42% versus 31%, P =0.02), live with a spouse (60% versus 47%, P =0.01), feel close to ≥3 individuals (84% versus 71%, P <0.01), have history of dyslipidemia (45 versus 34%, P =0.02), have thrombectomy (15% versus 8%, P =0.02), but less likely to have a history of smoking (17% versus 32%, P <0.001), coronary artery disease (14% versus 21%, P =0.04), and heart failure (3% versus 11%, P <0.01). Multivariable logistic regression analyses revealed that multiple socio-economic factors and prestroke comorbid diseases predicted fulfillment of transition of care measures. There was no difference in outcomes during the Covid-19 pandemic (2020–2021) compared with prepandemic years (2018–2019). CONCLUSIONS: One in 3 patients did not attain adequate 30-day transition of care behaviors. Their achievement varied substantially among different measures and was influenced by multiple socioeconomic and clinical factors. Interventions aimed at facilitating transition of care from hospital after stroke are needed. Registration: URL: https://clinicaltrials.gov/ ; Unique identifier: NCT 03452813.

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Prompt Outpatient Care For Older Adults Discharged From The Emergency Department Reduces Recidivism

Cited by 9 publications

References 30 publications

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Association of Geriatric Emergency Department post‐discharge referral order and follow‐up with healthcare utilization

Factors and Behaviors Related to Successful Transition of Care After Hospitalization for Ischemic Stroke

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