A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

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• 作者：Richard B. Balaban MD ; Alison A. Galbraith MD ; MPH…
• 关键词：care transitions ; continuity of care ; health care delivery ; patient safety ; underserved populations
• 刊名：Journal of General Internal Medicine
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：30
• 期：7
• 页码：907-915
• 全文大小：706 KB
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• 作者单位：Richard B. Balaban MD (1) (2)
  Alison A. Galbraith MD, MPH (2) (3)
  Marguerite E. Burns PhD (4)
  Catherine E. Vialle-Valentin MD (2) (3)
  Marc R. Larochelle MD (2) (3)
  Dennis Ross-Degnan ScD (2) (3)
  
  1. Cambridge Health Alliance, Harvard Medical School, Somerville Hospital Primary Care, 236 Highland Ave., Somerville, MA, 02143, USA
  2. Harvard Medical School, Somerville, MA, USA
  3. Harvard Pilgrim Health Care Institute, Boston, MA, USA
  4. University of Wisconsin, Madison, WI, USA
  
• 刊物主题：Internal Medicine;
• 出版者：Springer US
• ISSN：1525-1497

文摘

Background Evidence-based interventions to reduce hospital readmissions may not generalize to resource-constrained safety-net hospitals. Objective To determine if an intervention by patient navigators (PNs), hospital-based Community Health Workers, reduces readmissions among high risk, low socioeconomic status patients. Design Randomized controlled trial. Participants General medicine inpatients having at least one of the following readmission risk factors: (1) age?≥60 years, (2) any in-network inpatient admission within the past 6?months, (3) length of stay?≥3?days, (4) admission diagnosis of heart failure, or (5) chronic obstructive pulmonary disease. The analytic sample included 585 intervention patients and 925 controls. Interventions PNs provided coaching and assistance in navigating the transition from hospital to home through hospital visits and weekly telephone outreach, supporting patients for 30?days post-discharge with discharge preparation, medication management, scheduling of follow-up appointments, communication with primary care, and symptom management. Main Measures The primary outcome was in-network 30-day hospital readmissions. Secondary outcomes included rates of outpatient follow-up. We evaluated outcomes for the entire cohort and stratified by patient age >60?years (425 intervention/584 controls) and ?0?years (160 intervention/341 controls). Key Results Overall, 30-day readmission rates did not differ between intervention and control patients. However, the two age groups demonstrated marked differences. Intervention patients >60?years showed a statistically significant adjusted absolute 4.1?% decrease [95?% CI: ?.0?%, -0.2?%] in readmission with an increase in 30-day outpatient follow-up. Intervention patients ?0?years showed a statistically significant adjusted absolute 11.8?% increase [95?% CI: 4.4?%, 19.0?%] in readmission with no change in 30-day outpatient follow-up. Conclusions A patient navigator intervention among high risk, safety-net patients decreased readmission among older patients while increasing readmissions among younger patients. Care transition strategies should be evaluated among diverse populations, and younger high risk patients may require novel strategies.