When elderly patients are discharged home following an acute hospitalization, they are at high risk of having an unsuccessful transition with untoward health care outcomes. We developed an interdisciplinary, comprehensive intervention to try to make this transfer of a higher quality and less dangerous. In addition to enhancing satisfaction with the discharge, we hoped to reduce read‐missions and visits to the emergency department (ED) within 30 days of discharge.
The study employed a pre‐poststudy design at 3 hospitals — 1 each in Maryland, North Carolina, and Pennsylvania. Patients > 65 years admitted to the medical service were eligible. A 3‐month usual care control period, baseline, and outcomes data were collected. Then after training of inpatient health care providers, a newly developed, multifaceted discharge tool kit was implemented that focused on geriatric principles of care. Differences between the periods were assessed by chi‐square tests, and site effects were examined by interaction terms and Breslow‐Day statistics.
Two hundred and ninety‐six patients were followed during the control period, and 232 were exposed to the intervention. Fewer participants sought care in an ED within 3 days of discharge (10% vs. 3%, OR = 0.25 [CI = 0.10‐0.62], P = .003). Moreover, within 30 days of incident hospital discharge, there were both decreases in the rate of readmission (22% versus 14%, OR = 0.5 [CI = 0.3‐0.6], P = .03) and visits to the ED (30% vs. 20%, OR = 0.6 [CI = 0.4‐1.0], P = .06). As Coleman's Care Transition Measures (CTM) scores of 72 or greater signal high‐quality transitions from the hospital, the proportion of patients with such scores increased from 68% to 89% (OR = 3.5 [CI = 2.1‐5.9], P ≤ .001). Analysis of medication errors following discharge is ongoing.
With the aging of the population and the prolonged survival of patients with chronic illness, innovative approaches involving interdisciplinary, coordinated inpatient care appear to enhance the transition from hospital to home.
P. Dedhia, SHM, John A. Hartford Foundation, research funding; E. Howell, SHM, John A. Hartford Foundation, research funding; T. Hinson, SHM, John A. Hartford Foundation, research funding; J. Bulger, SHM, John A. Hartford Foundation, research funding.
To cite this abstract:Dedhia P, Howell E, Hinson T, Bulger J, Kravet S, Hess‐Landis R, Wright S. Enhancing the Transition from Hospital to Home for the Older Adult (Safe STEP — Safe and Successful Transition of Elderly Patients). Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 16. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/enhancing-the-transition-from-hospital-to-home-for-the-older-adult-safe-step-safe-and-successful-transition-of-elderly-patients/. Accessed May 26, 2019.