Identifying keys to success in reducing readmissions using the ideal transitions in care framework

BMC Health Services Research

Gregory J Misky¹  Allan V Prochazka³  Ruixin Guo²  Robert E Burke³ 

[1]Hospital Medicine Section, Division of General Internal Medicine, University of Colorado School of Medicine, Denver, USA

[2]Department of Biostatistics and Informatics, University of Colorado School of Public Health, Denver, USA

[3]Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, USA

关键词: Interventions;    Framework;    Readmissions;   

Others  :  1126238
DOI  :  10.1186/1472-6963-14-423

 received in 2014-04-14, accepted in 2014-09-16,  发布年份 2014

【 摘 要 】

Background

Systematic attempts to identify best practices for reducing hospital readmissions have been limited without a comprehensive framework for categorizing prior interventions. Our research aim was to categorize prior interventions to reduce hospital readmissions using the ten domains of the Ideal Transition of Care (ITC) framework, to evaluate which domains have been targeted in prior interventions and then examine the effect intervening on these domains had on reducing readmissions.

Methods

Review of literature and secondary analysis of outcomes based on categorization of English-language reports published between January 1975 and October 2013 into the ITC framework.

Results

66 articles were included. Prior interventions addressed an average of 3.5 of 10 domains; 41% demonstrated statistically significant reductions in readmissions. The most common domains addressed focused on monitoring patients after discharge, patient education, and care coordination. Domains targeting improved communication with outpatient providers, provision of advanced care planning, and ensuring medication safety were rarely included. Increasing the number of domains included in a given intervention significantly increased success in reducing readmissions, even when adjusting for quality, duration, and size (OR per domain, 1.5, 95% CI 1.1 - 2.0). The individual domains most associated with reducing readmissions were Monitoring and Managing Symptoms after Discharge (OR 8.5, 1.8 - 41.1), Enlisting Help of Social and Community Supports (OR 4.0, 1.3 - 12.6), and Educating Patients to Promote Self-Management (OR 3.3, 1.1 - 10.0).

Conclusions

Interventions to reduce hospital readmissions are frequently unsuccessful; most target few domains within the ITC framework. The ITC may provide a useful framework to consider when developing readmission interventions.

【 授权许可】

   
2014 Burke et al.; licensee BioMed Central Ltd.

【 图 表 】

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