Impact of a Follow-up Telephone Call Program on 30-Day Readmissions (FUTR-30)

Yiadom, Maame Yaa A. B.; Domenico, Henry J.; Byrne, Daniel W.; Hasselblad, Michele; Kripalani, Sunil; Choma, Neesha N.; Tucker-Marlow, Sarah; Gatto, Cheryl L.; Wang, Li; Bhatia, Monisha C; Morrison, Johnston; Harrell, Frank E.; Hartert, Tina V.; Lindsell, Christopher J.; Bernard, Gordon R.

doi:10.1097/mlr.0000000000001353

Cited by 11 publications

(22 citation statements)

References 28 publications

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“…Following title and abstract screening, 274 full texts were retrieved. A total of 126 RCTs involving 97 408 participants met our inclusion criteria (Figure 2). The study characteristics are presented in eAppendix 3 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

“…Across 41 studies (45 direct comparisons) involving 28 034 participants, only low-complexity interventions (OR, 0.68; 95% CI, 0.48 to 0.96) were associated decreased odds of ED visits compared with usual care (Figure 5). The P -score showed that low-complexity interventions ( P -Score, 87%) were associated with the most efficacy in reducing the odds of the ED visits.…”

Section: Resultsmentioning

confidence: 99%

“…Across 42 studies (53 direct comparisons) involving 31 988 participants, none of the 3 intervention intensities were significantly associated with reducing mortality compared with usual care (Figure 5). Global heterogeneity of the network was seen to be very low ( I 2 = 0%; 95% CI, 0% to 36%), and there was no evidence of inconsistency in the model (eAppendix 5 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

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Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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ImportanceDischarge from the hospital to the community has been associated with serious patient risks and excess service costs.ObjectiveTo evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community.Data SourcesCENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022.Study SelectionRandomized clinical trials evaluating transitional care interventions from hospitals to the community were identified.Data Extraction and SynthesisAt least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Main Outcomes and MeasuresThe primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake.ResultsOverall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, −0.20; 95% CI, −0.38 to −0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits.Conclusions and RelevanceThese findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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“…30,31 Chhabra et al studied the effect of hospital readmissions following specific orthopaedic procedures covered by Medicare and found that, after 2013, there was a significant reduction in post-surgical readmissions, suggesting that the imposition of penalties was reflected in the readmission rate. 32 In cardiology, geriatrics, neurology, pulmonology, and other specialties, there are many successful initiative programs to reduce hospital readmission, employing technologies such as telemedicine and use of messaging by applications on mobile phones 33,34 and that could be applicable in cases of hospital readmission after surgery for correction of vertebral fractures.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach

Nunes

Pinheiro

Costa

et al. 2022

Health Planning & Management

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Background Readmission followed by surgery to treat spinal fractures has a substantial impact on patient care costs and reflects a hospital's quality standards. This article analyzes the factors associated with hospital readmission followed by surgery to treat spinal fractures. Methods This was a cross‐sectional study with time‐series analysis. For prediction analysis, we used Cox proportional hazards and machine‐learning models, using data from the Healthcare Cost and Utilization Project, Inpatient Database from Florida (USA). Results The sample comprised 215,999 patients, 8.8% of whom were readmitted within 30 days. The factors associated with a risk of readmission were male sex (1.1 [95% confidence interval 1.06–1.13]) and >60 years of age (1.74 [95% CI: 1.69–1.8]). Surgeons with a higher annual patient volume presented a lower risk of readmission (0.61 [95% CI: 0.59–0.63]) and hospitals with an annual volume >393 presented a lower risk (0.92 [95% CI: 0.89–0.95]). Conclusion Surgical procedures and other selected predictors and machine‐learning models can be used to reduce 30‐day readmissions after spinal surgery. Identification of patients at higher risk for readmission and complications is the first step to reducing unplanned readmissions.

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“…A randomized trial including 3054 patients showed no evidence of an impact on 30day readmissions from a hospital-managed nurse follow-up telephone call program within 3 to 7 days of discharge, designed to assess understanding and provide education and assistance to support discharge plan implementation, but not provide ongoing continuity of care [11]. GeriPACT provides continuity of care and advanced open access scheduling to accommodate patient and caregiver needs.…”

Section: Discussionmentioning

confidence: 99%

The GeriPACT Initiative to Prevent All-Cause 30-Day Readmission in High Risk Elderly

et al. 2021

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Background: Suboptimal care transitions increases the risk of adverse events resulting from poor care coordination among providers and healthcare facilities. The National Transition of Care Coalition recommends shifting the discharge paradigm from discharge from the hospital, to transfer with continuous management. The patient centered medical home is a promising model, which improves care coordination and may reduce hospital readmissions. Methods: This is a quality improvement report, the geriatric patient-aligned care team (GeriPACT) at Tennessee Valley Healthcare System (TVHS) participated in ongoing quality improvement (Plan, Do, Study, Act (PDSA)) cycles during teamlet meetings. Post home discharge follow-up for GeriPACT patients was provided by proactive telehealth communication by the Registered Nurse (RN) care manager and nurse practitioner. Periodic operations data obtained from the Data and Statistical Services (DSS) coordinator informed the PDSA cycles and teamlet meetings. Results: at baseline (July 2018–June 2019) the 30-day all-cause readmission for GeriPACT was 21%. From July to December 2019, 30-day all-cause readmissions were 13%. From January to June 2020, 30-day all-cause readmissions were 15%. Conclusion: PDSA cycles with sharing of operations data during GeriPACT teamlet meetings and fostering a shared responsibility for managing high-risk patients contributes to improved outcomes in 30-day all-cause readmissions.

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Impact of a Follow-up Telephone Call Program on 30-Day Readmissions (FUTR-30)

Cited by 11 publications

References 28 publications

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach

The GeriPACT Initiative to Prevent All-Cause 30-Day Readmission in High Risk Elderly

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