Hospital readmissions remain highly prevalent despite being the target of policies and financial penalties. Evidence comparing effectiveness and costs of interventions to reduce readmissions is lacking, leaving healthcare systems with little guidance on how to improve quality and avoid costly penalties. Effective interventions likely need to bridge inpatient and outpatient settings, incorporate information technology, and utilize dedicated providers. Such complex innovations will require rigorous evaluation. Quality improvement research provides an approach to improve care locally and contribute to closing knowledge gaps. This trial studies a comprehensive intervention incorporating these recommendations into an Integrated Practice Unit, called Transition Services, and aims to reduce 30-day readmission rates. Methods:
AIRTIGHT is a non-blinded, pragmatic, controlled trial with two parallel groups evaluating the effect of referral to a provider-led Integrated Practice Unit, inclusive of comprehensive multidisciplinary care, dedicated paramedicine providers, and virtual visits, on 30-day readmission rates for high-risk hospitalized patients. An automated risk scoring system randomly generates referrals to Transition Services or Usual Care for a goal of 1520 hospitalized patients who score as high-risk for readmission. Transition Services engages patients in the hospital using a Patient Navigator and bridges outpatient services for the 30 days following discharge. Outcomes data are retrieved electronically from administrative medical records. After reapplication of inclusion and exclusion criteria at hospital discharge, analyses will follow intention to treat, such that patients will be analyzed based on initial randomized referral group. Because the evaluation is designed in part to inform healthcare system strategy, interim implementation metrics are reported to guide quality improvement. Metrics include patient capture rates and observed versus expected readmission rates for patients participating in the intervention.
Results: At the time of the interim results (July 2016), 421 patients were referred to Transition Services. Participants were more likely to be male, have Medicaid or lack insurance, and be slightly younger than those who did not participate. Of 421 patients referred, 139 (or 33%) participated in Transition Services. Of the 125 patients eligible for readmission analysis, 7 were readmitted (raw rate = 5.6%). The risk-adjusted expected rate is 12% or 15 readmissions.
Conclusions : The hospital transition program under study is complex and integrates the latest recommended readmission reduction strategies. Transition Services appears to be associated with a much lower than expected readmission rate (5.6% versus 12%). However, the majority (67%) of high-risk patients do not participate. During the next phase, the program will require significant modification to improve participation and generalizability.
To cite this abstract:
McWilliams, AD; Roberge, J; Rossman, W; Moore, CG; Ashby, A; Murphy, S; McCall, S; Brown, RA; Carpenter, S; Furney, S; Rissmiller, S . AIMING TO IMPROVE READMISSIONS THROUGH INTEGRATED HOSPITAL TRANSITIONS (AIRTIGHT): INTERIM RESULTS FROM A RANDOMIZED CONTROLLED QUALITY IMPROVEMENT TRIAL. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.
Journal of Hospital Medicine.
2017; 12 (suppl 2).
https://www.shmabstracts.com/abstract/aiming-to-improve-readmissions-through-integrated-hospital-transitions-airtight-interim-results-from-a-randomized-controlled-quality-improvement-trial/. Accessed January 20, 2020.
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