OBJECTIVES: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital. DESIGN: Randomized controlled trial. SETTING: Large multispecialty group practice. PARTICIPANTS: Individuals aged 65 and older discharged from hospital to home. INTERVENTION: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule a posthospitalization office visit. MEASUREMENTS: An outpatient office visit with a primary care provider after discharge and rehospitalization within 30 days after discharge. RESULTS: Of the 1,870 discharges in the intervention group, 27.7% had an office visit with a primary care provider within 7 days of discharge. Of the 1,791 discharges in the control group, 28.3% had an office visit with a primary care provider within 7 days of discharge. In the intervention group, 18.8% experienced a rehospitalization within the 30-day period after discharge, compared with 19.9% in the control group. The hazard ratio for an office visit with a primary care physician did not significantly differ between the intervention and control groups. The hazard ratio for rehospitalization in the 30-day period after hospital discharge in the intervention versus the control group was 0.94 (95% confidence interval = 0.81-1.1). CONCLUSION: This electronic health record-based intervention did not have a significant effect on the timeliness of office visits to primary care providers after hospitalization or risk of rehospitalization.
RCT Entities:
OBJECTIVES: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital. DESIGN: Randomized controlled trial. SETTING: Large multispecialty group practice. PARTICIPANTS: Individuals aged 65 and older discharged from hospital to home. INTERVENTION: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule a posthospitalization office visit. MEASUREMENTS: An outpatient office visit with a primary care provider after discharge and rehospitalization within 30 days after discharge. RESULTS: Of the 1,870 discharges in the intervention group, 27.7% had an office visit with a primary care provider within 7 days of discharge. Of the 1,791 discharges in the control group, 28.3% had an office visit with a primary care provider within 7 days of discharge. In the intervention group, 18.8% experienced a rehospitalization within the 30-day period after discharge, compared with 19.9% in the control group. The hazard ratio for an office visit with a primary care physician did not significantly differ between the intervention and control groups. The hazard ratio for rehospitalization in the 30-day period after hospital discharge in the intervention versus the control group was 0.94 (95% confidence interval = 0.81-1.1). CONCLUSION: This electronic health record-based intervention did not have a significant effect on the timeliness of office visits to primary care providers after hospitalization or risk of rehospitalization.
Authors: Jennifer Tjia; Terry S Field; Lawrence D Garber; Jennifer L Donovan; Abir O Kanaan; Marsha A Raebel; Yanfang Zhao; Jacquelyne C Fuller; Shawn J Gagne; Shira H Fischer; Jerry H Gurwitz Journal: Am J Manag Care Date: 2010-07 Impact factor: 2.229
Authors: Christopher O Phillips; Scott M Wright; David E Kern; Ramesh M Singa; Sasha Shepperd; Haya R Rubin Journal: JAMA Date: 2004-03-17 Impact factor: 56.272
Authors: Sarah L Cutrona; Hassan Fouayzi; Laura Burns; Rajani S Sadasivam; Kathleen M Mazor; Jerry H Gurwitz; Lawrence Garber; Devi Sundaresan; Thomas K Houston; Terry S Field Journal: J Gen Intern Med Date: 2017-08-14 Impact factor: 5.128