Md. Naylor et al., Comprehensive discharge planning and home follow-up of hospitalized elders- A randomized clinical trial, J AM MED A, 281(7), 1999, pp. 613-620
Citations number
37
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Context Comprehensive discharge planning by advanced practice nurses has de
monstrated short-term reductions in readmissions of elderly patients, but t
he benefits of more intensive follow-up of hospitalized elders at risk for
poor outcomes after discharge has not been studied.
Objective To examine the effectiveness of an advanced practice nurse-center
ed discharge planning and home follow-up intervention for elders at risk fo
r hospital readmissions.
Design Randomized clinical trial with follow-up at 2, 6, 12, and 24 weeks a
fter index hospital discharge.
Setting Two urban, academically affiliated hospitals in Philadelphia, Pa.
Participants Eligible patients were 65 years or older, hospitalized between
August 1992 and March 1996, and had 1 of several medical and surgical reas
ons for admission.
Intervention Intervention group patients received a comprehensive discharge
planning and home follow-up protocol designed specifically for elders at r
isk for poor outcomes after discharge and implemented by advanced practice
nurses.
Main Outcome Measures Readmissions, time to first readmission, acute care v
isits after discharge, costs, functional status, depression, and patient sa
tisfaction.
Results A total of 363 patients (186 in the control group and 177 in the in
tervention group) were enrolled in the study; 70% of intervention and 74% o
f control subjects completed the trial. Mean age of sample was 75 years; 50
% were men and 45% were black. By week 24 after the index hospital discharg
e, control group patients were more likely than intervention group patients
to be readmitted at least once (37.1% vs 20.3%; P < .001). Fewer intervent
ion group patients had multiple readmissions (6.2% vs 14.5%; P = .01) and t
he intervention group had fewer hospital days per patient (1.53 vs 4.09 day
s; P < .001). Time to first readmission was increased in the intervention g
roup (P < .001). At 24 weeks after discharge, total Medicare reimbursements
for health services were about $1.2 million in the control group vs about
$0.6 million in the intervention group (P < .001). There were no significan
t group differences in postdischarge acute care visits, functional status,
depression, or patient satisfaction.
Conclusions An advanced practice nurse-centered discharge planning and home
care intervention for at-risk hospitalized elders reduced readmissions, le
ngthened the time between discharge and readmission, and decreased the cost
s of providing health care. Thus, the intervention demonstrated great poten
tial in promoting positive outcomes for hospitalized elders at high risk fo
r rehospitalization while reducing costs.