Reducing Hospital Readmissions Through a Skilled Nursing Facility Discharge Intervention: A Pragmatic Trial

Gardner, Rebekah; Pelland, Kimberly; Youssef, Rouba; Morphis, Blake; Calandra, Kathleen; Hollands, Lara; Gravenstein, Stefan

doi:10.1016/j.jamda.2019.10.001

Cited by 16 publications

(9 citation statements)

References 17 publications

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“…This integrative review explored the relationships between the RED and BOOST model components, related them to the CC Atlas activity domains, and identified facilitators and barriers to implementation and associated outcomes across studies in 50 hospitals and 18 skilled nursing facilities. 24–36,43 Similar to other studies in the outpatient setting 18,19 this review reports the utility of the CC Atlas as a framework for analysis of acute hospital and skilled nursing facility CC activities. This review added to what we understand about how the transitional models’ components relate to each other, compare to each other, and mapped to the corresponding CC Atlas activity domain.…”

Section: Discussionmentioning

confidence: 80%

“…In studies of rehospitalizations from skilled nursing facilities, Berkowitz et al 25 reported a decrease from 18.9% before RED implementation to 10.2% after implementation (p < 0.05). Similarly, Gardner et al 36 found a 1.7% decrease after RED implementation (p < 0.001).…”

Section: Model Outcomesmentioning

confidence: 75%

“…21 Two widely implemented and tested transitional care models chosen for this review are the RED 15 (See Table 3) and BOOST 23 (Table 4) which were both designed primarily to reduce hospital readmissions, emergency department visits, and adverse outcomes 14,22,23 and have substantial evidence that they reduce 30-day all-cause hospital readmission rates. 16,[24][25][26][27][28][29][30][31][32][33][34][35][36] Although the CC Atlas was used successfully in studies on CC measurement, 18,19 no information is known about how the CC Atlas could be used to explore the components of transitional care models such as the RED and BOOST models. This paper reports the results of an integrative review conducted to better understand how individual components of RED and BOOST might relate to each other within the CC Atlas domains, similarities and differences in component implementation effects, and the models' effects on outcomes.…”

Section: Transitional Care Modelsmentioning

confidence: 99%

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Utilizing the care coordination Atlas as a framework: An integrative review of transitional care models

Chakurian

Popejoy

2021

International Journal of Care Coordination

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Introduction Care coordination reduces care fragmentation and costs while improving health care quality. Transitional care programs, guided by tested models are an important component of effective care coordination, and have been found to reduce adverse events and prevent hospital readmissions. Using the Care Coordination Atlas as a framework, this article reports an integrative review of two transitional care models including analysis of model components, implementation factors, and associated 30-day all-cause hospital readmission rates. Methods Integrative review methodology. PubMed and Scopus databases were searched from January 2015 to July 2020. Fourteen studies set in 18 skilled nursing facilities and 50 hospitals were selected for data extraction and analysis. Results The ReEngineered Discharge model had five components and the Better Outcomes by Optimizing Safe Transitions model had eight components in the nine Care Coordination Atlas domains. Communication dominated activities in both models while neither addressed accountability/responsibility. Implementation was influenced by leadership commitment to understanding complexity of the models, culture change, integration of models into workflows, and associated labor costs. Model implementation studies consistently reported improvements in facilities’ 30-day all-cause hospital readmission rates. Discussion The Care Coordination Atlas was a useful framework to guide analysis of transitional care models. Leadership commitment to and participation in model implementation is vital. The models do not focus beyond the immediate post-discharge period limiting the impact on chronic disease management. Frameworks such as the Care Coordination Atlas are useful to help guide development of care coordination activities and associations with readmission rates.

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Section: Discussionmentioning

confidence: 80%

Section: Model Outcomesmentioning

confidence: 75%

Section: Transitional Care Modelsmentioning

confidence: 99%

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Utilizing the care coordination Atlas as a framework: An integrative review of transitional care models

Chakurian

Popejoy

2021

International Journal of Care Coordination

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“…When the study started, it was unknown whether SNFs would be able to successfully implement RED, which was designed for hospitals, as SNFs are substantially different than hospitals. As with other RED implementation studies in SNFs (Berkowitz et al, 2013; Gardner et al, 2020) were also able to do so successfully with minimal adaptation of the RED processes, for example, how to implement processes such as teach back technique in the nursing home (Popejoy et al, 2020a). Outcomes from these studies all indicate that RED is a program that can reduce hospital readmissions post SNF discharge.…”

Section: Discussionmentioning

confidence: 69%

“…The first SNF RED study, in a subacute unit located within a 450-bed long term care hospital, reported significant reductions in 30-day rehospitalization compared to historical controls (18.9% vs.10.2%, p < .05), and an 18.5% ( p < .003) increase in patient attendance to outpatient appointments (Berkowitz et al, 2013). A more recent study compared 13 SNFs that implemented RED to 38 matched controls and found a relative decrease in rehospitalizations of 0.9% ( p < .001) within 30 days of SNF discharge to the community, and a 1.7% decrease ( p < .001) within 30 days of the index hospitalization (Gardner et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Testing Re-Engineered Discharge Program Implementation Strategies in SNFs

et al. 2020

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The Re-Engineered Discharge (RED) program, designed for hospitals, is being trialed in skilled nursing facilities (SNFs) with promising results. This paper reports on the quantitative results of a multimethod study testing two different RED program implementation strategies in SNFs. A pretest-posttest design was used to compare utilization outcomes of two different RED implementation strategies (Enhanced and Standard) and overall group differences in four Midwestern SNFs. In the Standard group there were higher odds of being readmitted in the pre-intervention versus post-intervention period. After adjusting coefficients using Poisson regression, in the pre-intervention period the adjusted number of rehospitalizations for the Standard group was 45% higher at 30 days, 50% higher at 60 days ( p = .01), and 39% higher at 180 days ( p = .001). SNF RED may be a useful program to reduce rehospitalizations after discharge. Benefit of SNF RED is dependent on degree of adoption of the intervention.

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Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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ImportanceDischarge from the hospital to the community has been associated with serious patient risks and excess service costs.ObjectiveTo evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community.Data SourcesCENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022.Study SelectionRandomized clinical trials evaluating transitional care interventions from hospitals to the community were identified.Data Extraction and SynthesisAt least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Main Outcomes and MeasuresThe primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake.ResultsOverall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, −0.20; 95% CI, −0.38 to −0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits.Conclusions and RelevanceThese findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

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Reducing Hospital Readmissions Through a Skilled Nursing Facility Discharge Intervention: A Pragmatic Trial

Cited by 16 publications

References 17 publications

Utilizing the care coordination Atlas as a framework: An integrative review of transitional care models

Utilizing the care coordination Atlas as a framework: An integrative review of transitional care models

Testing Re-Engineered Discharge Program Implementation Strategies in SNFs

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

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