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A Reengineered Hospital Discharge Program to Decrease Rehospitalization : A Randomized Trial

JACK, Brian W ; CHETTY, Veerappa K ; MARTIN, Stephen ; CULPEPPER, Larry ; ANTHONY, David ; GREENWALD, Jeffrey L ; SANCHEZ, Gail M ; JOHNSON, Anna E ; FORSYTHE, Shaula R ; O'DONNELL, Julie K ; PAASCHE-ORLOW, Michael K ; MANASSEH, Christopher

Annals of internal medicine, 2009-02, Vol.150 (3), p.178-187 [Periódico revisado por pares]

Philadelphia, PA: American College of Physicians

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  • Título:
    A Reengineered Hospital Discharge Program to Decrease Rehospitalization : A Randomized Trial
  • Autor: JACK, Brian W ; CHETTY, Veerappa K ; MARTIN, Stephen ; CULPEPPER, Larry ; ANTHONY, David ; GREENWALD, Jeffrey L ; SANCHEZ, Gail M ; JOHNSON, Anna E ; FORSYTHE, Shaula R ; O'DONNELL, Julie K ; PAASCHE-ORLOW, Michael K ; MANASSEH, Christopher
  • Assuntos: Adult ; Aged ; Biological and medical sciences ; Boston ; Clinical outcomes ; Cost Savings ; Discharge ; Emergency Service, Hospital - economics ; Emergency Service, Hospital - standards ; Female ; General aspects ; Health care management ; Hospitalization ; Hospitals, University - economics ; Hospitals, University - statistics & numerical data ; Hospitals, Urban - economics ; Hospitals, Urban - statistics & numerical data ; Humans ; Intervention ; Male ; Medical sciences ; Middle Aged ; Outcome Assessment (Health Care) ; Patient Care Team ; Patient Discharge - standards ; Patient Education as Topic
  • É parte de: Annals of internal medicine, 2009-02, Vol.150 (3), p.178-187
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-News-2
    ObjectType-Feature-3
    content type line 23
    Analysis and interpretation of the data: B.W. Jack, V.K. Chetty, D. Anthony, J.L. Greenwald, A.E. Johnson, S.R. Forsythe, J.K. O'Donnell, M.K. Paasche-Orlow, S. Martin, L. Culpepper.
    Critical revision of the article for important intellectual content: B.W. Jack, V.K. Chetty, J.L. Greenwald, G.M. Sanchez, A.E. Johnson, S.R. Forsythe, J.K. O'Donnell, M.K. Paasche-Orlow, L. Culpepper.
    Obtaining of funding: B.W. Jack, D. Anthony.
    Author Contributions: Conception and design: B.W. Jack, V.K. Chetty, D. Anthony, J.L. Greenwald, G.M. Sanchez, C. Manasseh, L. Culpepper.
    Dr. Paasche-Orlow: Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118.
    Collection and assembly of data: B.W. Jack, G.M. Sanchez, A.E. Johnson, S.R. Forsythe, J.K. O'Donnell.
    Final approval of the article: B.W. Jack, V.K. Chetty, J.L. Greenwald, G.M. Sanchez, A.E. Johnson, S.R. Forsythe, J.K. O'Donnell, M.K. Paasche-Orlow, C. Manasseh, S. Martin, L. Culpepper.
    Administrative, technical, or logistic support: B.W. Jack, V.K. Chetty, D. Anthony, A.E. Johnson, J.K. O'Donnell, C. Manasseh.
    Dr. Sanchez: Boston Medical Center, 88 East Newton Street, Boston, MA 02118.
    Current author addresses and author contributions are available at www.annals.org.
    Dr. Anthony: Department of Family Medicine, Brown University Alpert Medical School, 111 Brewster Street, Pawtucket, RI 02860.
    Drafting of the article: B.W. Jack, D. Anthony, J.L. Greenwald, G.M. Sanchez, A.E. Johnson, S.R. Forsythe, J.K. O'Donnell, M.K. Paasche-Orlow.
    Statistical expertise: V.K. Chetty, M.K. Paasche-Orlow.
    Dr. Greenwald: Hospital Medicine Unit, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118.
    Current Author Addresses: Drs. Jack, Chetty, Manasseh, Martin, and Culpepper; Ms. Johnson; Ms. Forsythe; and Ms. O'Donnell: Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, 1 BMC Place, Dowling 5 South, Boston, MA 02118.
    Provision of study materials or patients: B.W. Jack, A.E. Johnson, M.K. Paasche-Orlow, C. Manasseh.
  • Descrição: Emergency department visits and rehospitalization are common after hospital discharge. To test the effects of an intervention designed to minimize hospital utilization after discharge. Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card. General medical service at an urban, academic, safety-net hospital. 749 English-speaking hospitalized adults (mean age, 49.9 years). A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers' follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment. Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed. This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report. A package of discharge services reduced hospital utilization within 30 days of discharge. Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute, National Institutes of Health.
  • Editor: Philadelphia, PA: American College of Physicians
  • Idioma: Inglês
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