Abstract
BackgroundUnplanned hospital admissions are costly and prevention of these has been a focus for research for decades. With this study we aimed to determine whether discharge planning including a single follow-up home visit reduces readmission rate. The intervention is not representing a new method but contributes to the evidence concerning intensity of the intervention in this patient group.MethodsThis study was a centrally randomized single-center controlled trial comparing intervention to usual care with investigator-blinded outcome assessment. Patients above the age of 65 were discharged from a single Danish hospital during 2013–2014 serving a rural and low socioeconomic area. For intervention patients study and department nurses reviewed discharge planning the day before discharge. On the day of discharge, study nurses accompanied the patient to their home, where they met with the municipal nurse. Together with the patient they reviewed cognitive skills, medicine, nutrition, mobility, functional status, and future appointments in the health care sector and intervened if appropriate.Readmission at any hospital in Denmark within 8, 30, and 180 days after discharge is reported. Secondary outcomes were time to first readmission, number of readmissions, length of stay, and readmission with Ambulatory Care Sensitive Conditions, visits to general practitioners, municipal services, and mortality.ResultsOne thousand forty-nine patients aged > 65 years discharged from medical, geriatric, emergency, surgical or orthopedic departments met inclusion criteria characteristic of frailty, e.g. low functional status, need of more personal help and multiple medications. Among 945 eligible patients, 544 were randomized. Seven patients died before discharge. 56% in the intervention group and 54% in the control group were readmitted (p = 0.71) and 23% from the intervention group and 22% from the control group died within 180 days. There were no significant differences between intervention and control groups concerning other secondary outcomes.ConclusionsThere was no effect of a single follow-up home visit on readmission in a group of frail elderly patients discharged from hospital.Trial registrationhttps://clinicaltrials.gov (identifier NCT02318680), retrospectively registered December 11, 2014.
Highlights
Unplanned hospital admissions are costly and prevention of these has been a focus for research for decades
It is important to bear in mind that the concept of ambulatory care sensitive conditions (ACSC) is theoretical and to our knowledge, no clinical trials have demonstrated hospitalizations due to ACSCdiagnoses to have a greater potential for being prevented than hospitalizations due to other diagnoses
With the present study we aim to complement the evidence concerning the effect of discharge planning by focusing on a single follow-up home visit administered to frail elderly patients living in a rural area of Denmark
Summary
Unplanned hospital admissions are costly and prevention of these has been a focus for research for decades. Unplanned admissions are costly and prevention of these has been a focus for research for decades. A large number of admissions are deemed “avoidable” for different reasons: 1) if the condition for which the patient is admitted could have been managed in primary care, and 2) if the patient is readmitted within 30 days from discharge implying that initial hospital treatment and discharge planning was insufficient [1]. The concept of ACSC diagnoses was originally described in 1976 and since it has been used as a performance indicator in the primary health care sector in several countries among these Denmark [3, 4]. Compared to other European countries Denmark has a high frequency of hospitalizations due to ACSC conditions [7]
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