A transition care coordinator model reduces hospital readmissions and costs
A transition care coordinator model reduces hospital readmissions and costs
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DOI：
10.1016/j.cct.2019.04.014
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发表时间：
2019-06-01
影响因子：
2.2
通讯作者：
Speroff, Theodore
中科院分区：
文献类型：
--
作者：
Kripalani, Sunil;Chen, Guanhua;Speroff, Theodore
背景资料：减少再入院的干预措施的最佳结构和强度仍然不确定，部分原因是缺乏头对头的比较。为了解决这一差距，我们评估了两种形式的循证，多组件的过渡期护理intervention.Methods：准实验评估设计比较结果的过渡期护理协调员（TCC）的护理，以家庭护理，同时控制社会人口特征，合并症，再入院风险和管理因素。该研究于2013年1月1日至2015年4月30日期间进行，作为质量改进计划。通过电子健康记录算法确定了因肺炎、充血性心力衰竭或慢性阻塞性肺疾病住院的合格成人（N = 7038）进行项目评价。护士TCC提供了一个完整的干预（提供在医院和出院后的电话）或部分干预（电话只）。结果：共762例住院TCC护理（460完全干预和302部分干预）和6276与牙科护理进行了检查。在多变量模型中，TCC Care住院治疗在30天（OR = 0.512，95% CI 0.392至0.668）和90天（OR = 0.591，95% CI 0.483至0.723）时的再入院几率显著较低。30天（差异= $3969，95%CI $5099至$2691）和90天（差异= $5684，95%CI $7602至$3627）的调整后成本显著较低。效果是相似的患者是否接受了全部或部分intervention.Conclusion：以证据为基础的多组分的干预提供护士TCCs减少30和90天的再入院和相关的医疗保健费用。出院后通过电话进行的低强度干预可能与住院计划具有相似的效果。
Background: The optimal structure and intensity of interventions to reduce hospital readmission remains uncertain, due in part to lack of head-to-head comparison. To address this gap, we evaluated two forms of an evidence-based, multi-component transitional care intervention.Methods: A quasi-experimental evaluation design compared outcomes of Transition Care Coordinator (TCC) Care to Usual Care, while controlling for sociodemographic characteristics, comorbidities, readmission risk, and administrative factors. The study was conducted between January 1, 2013 and April 30, 2015 as a quality improvement initiative. Eligible adults (N = 7038) hospitalized with pneumonia, congestive heart failure, or chronic obstructive pulmonary disease were identified for program evaluation via an electronic health record algorithm. Nurse TCCs provided either a full intervention (delivered in-hospital and by post-discharge phone call) or a partial intervention (phone call only).Results: A total of 762 hospitalizations with TCC Care (460 full intervention and 302 partial intervention) and 6276 with Usual Care was examined. In multivariable models, hospitalizations with TCC Care had significantly lower odds of readmission at 30 days (OR = 0.512, 95% CI 0.392 to 0.668) and 90 days (OR = 0.591, 95% CI 0.483 to 0.723). Adjusted costs were significantly lower at 30 days (difference = $3969, 95% CI $5099 to $2691) and 90 days (difference = $5684, 95% CI $7602 to $3627). The effect was similar whether patients received the full or partial intervention.Conclusion: An evidence-based multi-component intervention delivered by nurse TCCs reduced 30- and 90-day readmissions and associated health care costs. Lower intensity interventions delivered by telephone after discharge may have similar effectiveness to in-hospital programs.