Face-to-Face Meetings with Neurosurgical Patients Before Hospital Discharge: Impact on Telephone Outreach, Emergency Department Visits, and Hospital Readmissions.

Franz H Vergara,Nancy J Sullivan,Jean E Davis,Daniel J Sheridan,Chakra Budhathoki

doi:10.1089/pop.2019.0038

Franz H Vergara, Nancy J Sullivan + Show 3 more

Open Access

https://doi.org/10.1089/pop.2019.0038

Copy DOI

Abstract

The Johns Hopkins Community Health Partnerships (JCHiP) was developed in 2010 within the Johns Hopkins Health Systems. As part of JCHiP, the Patient Access Line call center was created. The average telephone reach rate at The Johns Hopkins Hospital in 2014 was only 53%. In a population of adult neurosurgical patients, this study aimed to: determine the impact of face-to-face meetings with neurosurgical patients before hospital discharge on telephone follow-up (TFU) reach rates, and determine the association between TFU reach rates and subsequent emergency department (ED) visits and hospital readmission rates. This quasi-experimental study used a posttest-only research design with a comparison group. Two adult inpatient neurosurgical units at the Johns Hopkins Hospital were selected as the intervention and comparison groups. A convenience sampling technique was used. Face-to-face meetings pre hospital discharge resulted in a TFU reach rate of 97.7% on the intervention unit while the comparison unit had only a 76.1% TFU reach rate (P < .001). Reached patients had fewer ED visits (7.8%) than not reached patients (17.4%); however, the difference was not statistically significant (P = .138). Reached patients also had fewer hospital readmissions (3.3%) than not reached patients (8.7%); this also was not statistically significant (P = .214). This study demonstrated that face-to-face meetings with neurosurgical patients prior to discharge increased TFU rates. Results were statistically significant. ED visits and hospital readmissions were also reduced in reached patients and the findings were clinically significant.

Highlights

In 2010, the Centers for Medicare & Medicaid Services awarded the Johns Hopkins Health Systems a grant to create and design a comprehensive and integrated health care program, the Johns Hopkins Community Health Partnerships ( JCHiP)
The intervention group, who received face-to-face meeting interventions, had a telephone follow-up (TFU) reach rate that was 21.6% higher than that of the comparison group. This indicated that pre hospital discharge face-to-face meeting interventions increased TFU reach rates, and Pearson’s chi-square test demonstrated very high statistical significance (P = .000) (Table 2)
The researchers conducted a statistical analysis comparing the number of TFU attempts to successfully reach the patient

Summary

Introduction

In 2010, the Centers for Medicare & Medicaid Services awarded the Johns Hopkins Health Systems a grant to create and design a comprehensive and integrated health care program, the Johns Hopkins Community Health Partnerships ( JCHiP). JCHiP was a complementary bundle of interventions with primary and secondary drivers (Figure 1) designed to improve access to care for high-risk adults and reduce hospital readmissions in East Baltimore, MD.[1] When deployed, it was associated with lower spending and improved health care outcomes by reducing an aggregate total cost of care of $59.8 million for Medicare and Medicaid participants.[2]. As a part of JCHiP, the Patient Access Line (PAL) call center was created to serve as a secondary driver to promote seamless transitions of care from hospital to home.[3] Hsiao et al[4] published a detailed explanation of the implementation of JCHiP and the PAL call center in a recent study.

Objectives

Methods

Results

Discussion

Conclusion