Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day Readmission Rates in a Case-managed Medicare Population

Graham, Jove; Tomcavage, Janet; Salek, Doreen; Sciandra, Joann; Davis, Duane E.; Stewart, Walter F.

doi:10.1097/mlr.0b013e318229433e

Cited by 31 publications

(37 citation statements)

References 12 publications

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“…IVR can obtain information from patients, deliver tailored instructions, and allow for remote monitoring [18]. Previous studies of IVR interventions have used quasi-experimental designs [19,20] and clinical trials [16,21] but have had mixed results; very little rigorous work has been done to evaluate IVR interventions focused on care transitions; thus a rigorous, real-world study of an IVR-based intervention to support care transitions in congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) was needed.…”

Section: Introductionmentioning

confidence: 99%

The E-Coach technology-assisted care transition system: a pragmatic randomized trial

Ritchie

Houston

Richman

et al. 2016

Behav. Med. Pract. Policy Res.

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Care transitions from the hospital to home remain a vulnerable time for many patients, especially for those with heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Despite regular use in chronic disease management, it remains unclear how technology can best support patients during their transition from the hospital. We sought to evaluate the impact of a technology-supported care transition support program on hospitalizations, days out of the community and mortality. Using a pragmatic randomized trial, we enrolled patients (511 enrolled, 478 analyzed) hospitalized with CHF/COPD to "E-Coach," an intervention with conditionspecific customization and in-hospital and postdischarge support by a care transition nurse (CTN), interactive voice response post-discharge calls, and CTN follow-up versus usual post-discharge care (UC). The primary outcome was 30-day rehospitalization. Secondary outcomes included (1) rehospitalization and death and (2) days in the hospital and out of the community. ECoach and UC groups were similar at baseline except for gender imbalance (p = 0.02). After adjustment for gender, our primary outcome, 30-day rehospitalization rates did not differ between the E-Coach and UC groups (15.0 vs. 16.3 %, adjusted hazard ratio [95 % confidence interval]: 0.94 [0.60, 1.49]). However, in the COPD subgroup, ECoach was associated with significantly fewer days in the hospital (0.5 vs.

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Section: Introductionmentioning

confidence: 99%

The E-Coach technology-assisted care transition system: a pragmatic randomized trial

Ritchie

Houston

Richman

et al. 2016

Behav. Med. Pract. Policy Res.

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“…4 One successful patient-centered medical home program integrated calls using an interactive voice response (IVR) system post-discharge into a pre-existing intensive case management program. 9 Despite the limited data on reducing readmissions, the primary care practice is well positioned to address many of the common breakdowns in patient care after hospitalization. For example, while inpatient nurses or health plan-based nurses may review discharge medications, in contrast, the primary care-based nurse can reconcile the discharge medication list with the pre-hospitalization medication list and identify discrepancies.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Primary Care-Based Post-Discharge Phone Call Program: Keeping the Primary Care Practice at the Center of Post-hospitalization Care Transition

2014

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BACKGROUND:The post-hospitalization period is a precarious time for patients. Post-discharge nurse telephone call programs aiming to prevent unnecessary readmissions have had mixed results. OBJECTIVE: Describe a primary-care based program to identify and address problems arising after hospital discharge. DESIGN: A quality improvement program embedding registered nurses in a primary care practice to call patients within 72 h of hospital discharge and route problems within the practice for real-time resolution. PARTICIPANTS: Adult patients with a primary care provider in the general internal medicine practice at the University of California San Francisco who were discharged home from the Medicine service. MAIN MEASURES: Patients reached directly by phone had a 'full-scripted encounter;' those reached only by voice-mail had a 'message-scripted encounter;' those not reached despite multiple attempts had a 'missed encounter.' Among patients with full-scripted encounters, we identified and cataloged problems arising after hospital discharge and measured the proportion of calls in which a problem was uncovered. For the different encounter types, we compared follow-up appointment attendance and 30-day readmission rates. KEY RESULTS: Of 790 eligible discharges, 486 had a full-scripted, 229 a message-scripted and 75 a missed encounter. Among the 486 full-scripted encounters, nurses uncovered at least one problem in 371 (76 %) discharges, 25 % of which (n=94) included new symptoms, and 47 % (n=173) included medication issues. Discharges with full-scripted and message-scripted encounters were associated with higher follow-up appointment attendance rates compared with those with missed encounters (60.1 %, 58.5 %, 38.5 % respectively p=0.004). There was no significant difference in 30-day readmission rates (12.8 %, 14.8 %, 14.7 %; p=0.72). CONCLUSIONS: Our results suggest that centering a post-discharge phone call program within the primary care practice improves post-hospital care by identifying clinical and care-coordination problems early. With the new Medicare transitional care payment, such programs could become an important, self-sustaining part of the patient-centered medical home.KEY WORDS: care management; care transitions; health care delivery; primary care; quality improvement.

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“…These patients were compared with 2420 matched control patients who received only case management services. The researchers reported that the patients who used the GMP with case management had a 44% reduction in 30-day readmission rates and concluded that investing in automated monitoring systems may reduce hospital readmissions (Graham, Tomcavage, Salek, Sciandra, Davis & Stewart, 2012).…”

Section: Telemedicine and Ehealthmentioning

confidence: 99%

Contributing Factors to Hospital Readmissions

Amalfitano¹

2013

Preprint

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Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day Readmission Rates in a Case-managed Medicare Population

Cited by 31 publications

References 12 publications

The E-Coach technology-assisted care transition system: a pragmatic randomized trial

The E-Coach technology-assisted care transition system: a pragmatic randomized trial

Evaluation of a Primary Care-Based Post-Discharge Phone Call Program: Keeping the Primary Care Practice at the Center of Post-hospitalization Care Transition

Contributing Factors to Hospital Readmissions

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