Multimodal Care Transition Intervention and Unplanned Readmission or Death in High-Risk Patients

A multimodal transitional care intervention for medical inpatients with an increased risk for hospital readmission was not associated with any significant decrease hospital readmissions, according to a study in JAMA Internal Medicine.

Investigators conducted a single-blinded, multicenter, randomized controlled trial (ClinicalTrials.gov Identifier: NCT03496896) to assess the effects of a transitional care intervention for higher-risk medical patients using a composite outcome of 30-day unplanned readmission or death.

Patients with an increased risk for unplanned readmissions and discharged from 4 hospitals in Switzerland from April 2018 to January 2020 were randomly assigned in a 1:1 ratio to receive a standardized multimodal care transition from a trained team of discharge nurses or usual care. The data were analyzed from April to September 2022.

Adult patients (aged ≥18 years) were eligible if their hospital stay was 1 day or longer, they had a higher risk of readmission (simplified HOSPITAL score ≥4 points), and they were scheduled to be discharged home or to a nursing home.

The intervention group included a predischarge component that involved identification of medication discrepancies in admission and discharge lists, a 15-minute patient education session about the patient’s main diseases with use of teach-back to confirm their understanding, and planning for the first postdischarge follow-up visit with their primary care physician within 7 days of discharge. The group also received educational materials. The control group received usual care from their managing hospitalist and a 1-page study information sheet.

The primary composite outcome was the number of patients who were discharged alive with an unplanned readmission or died from any cause within 30 days of discharge.

A total of 1386 participants (mean age, 72 [SD, 14] years; 51% men) were included in the primary analysis, 692 in the intervention group and 694 in the control group.

For the intervention group, the primary outcome occurred in 145 patients (21%; 95% CI, 18%-24%) compared with 134 patients (19%; 95% CI, 17%-22%; P =.44) in the control group. A secondary analysis of the per-protocol data confirmed the results. For the intention-to-treat analysis, the risk difference was 1.7% (95% CI, -2.5% to 5.9%; P =.44).

A total of 251 unplanned readmissions were recorded, and diagnoses were the same as for the index admissions in 33% of patients. No difference was observed between treatment groups for risk for unplanned readmissions without death, although strata-specific analyses demonstrated the same heterogeneity that occurred with the primary outcome.

In the intervention group, 32 patients died compared with 18 (P =.04) in the control group. The difference in mortality without unplanned readmission was not statistically significant, and no differences were found regarding health care use, patient satisfaction, or readmission costs in the intervention group.

Among several limitations, outcomes were limited to 30 days, and the participants could not be blinded, which could have resulted in different health behaviors. Also, several intervention components were not fully standardized, and the study may have been underpowered. In addition, the design did not allow assessment of which components worked or did not work.

“Results of this study suggest that the difficulties in preventing hospital readmissions continue, even when using multimodal interventions targeting higher-risk patients,” the researchers wrote.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor