Do post discharge phone calls improve care transitions? A cluster-randomized trial.

Abstract

ImportanceThe transition from hospital to home can expose patients to adverse events during the post discharge period. Post discharge care including phone calls may provide support for patients returning home but the impact on care transitions is unknown.ObjectiveTo examine the effect of a 72-hour post discharge phone call on the patient's transition of care experience.DesignCluster-randomized control trial.SettingUrban, academic medical center.ParticipantsGeneral medical patients age 18 and older discharged home after hospitalization.Main Outcomes and MeasuresPrimary outcome measure was the Care Transition Measure (CTM-3) score, a validated measure of the quality of care transitions. Secondary measures included self-reported adherence to medication and follow up plans, and 30-day composite of emergency department (ED) visits and hospital readmission.Results328 patients were included in the study over an 6-month period. 114 (69%) received a post discharge phone call, and 214 of all patients in the study completed the follow outcome survey (65% response rate). A small difference in CTM-3 scores was observed between the intervention and control groups (1.87 points, 95% CI 0.47–3.27, p = 0.01). Self-reported adherence to treatment plans, ED visits, and emergency readmission rates were similar between the two groups (odds ratio 0.57, 95% CI 0.13–2.45, 1.20, 95% CI 0.61–2.37, and 1.18, 95% CI 0.53–2.61, respectively).Conclusions and RelevanceA single post discharge phone call had a small impact on the quality of care transitions and no effect on hospital utilization. Higher intensity post discharge support may be required to improve the patient experience upon returning home.Trial RegistrationClinicalTrials.gov NCT01580774