Paul Y Takahashi1, James M Naessens2, Stephanie M Peterson2, Parvez A Rahman2, Nilay D Shah2, Dawn M Finnie2, Audrey J Weymiller3, Bjorg Thorsteinsdottir4, Gregory J Hanson5. 1. Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Kogod Center of Aging, Mayo Clinic, Rochester, MN, USA. Electronic address: takahashi.paul@mayo.edu. 2. Division of Health Care Policy & Research, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA. 3. University of Arkansas, Little Rock, AR, USA. 4. Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. 5. Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Kogod Center of Aging, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND: Care transition programs can potentially reduce 30 day readmission; however, the effect on long-term hospital readmissions is still unclear. OBJECTIVE: We compared short-term (30 day) and long-term (180 day) utilization of participants enrolled in care transitions versus those matched referents eligible but not enrolled. DESIGN: This cohort study was conducted from January 1, 2011 until June 30, 2013 within a primary care academic practice. PARTICIPANTS: Patients at high risk for hospital readmission based on age and comorbid health conditions had participated in care transitions group (cases) or usual care (referent). MAIN MEASURES: The primary outcomes were 30, 90, and 180 day hospital readmissions.. Secondary outcomes included: mortality; emergency room visits and days; combined rehospitalizations and emergency room visits; and total intensive care unit days. Cox proportional hazard models using propensity score matching were used to assess rehospitalization, emergency room visits and mortality. Poisson regression models were used to compare the numbers of hospital days. KEY RESULTS: Compared to referent (n=365), Mayo Clinic Care Transitions patients exhibited a lower 30 day rehospitalization rate compared to referent; 12.4% (95% CI 8.9-15.7) versus 20.1% (95% CI 15.8-24.1%), respectively (P=0.002). At 180-days, there was no difference in rehospitalization between transitions and referent; 39.9% (95% CI 34.6-44.9%) versus 44.8% (95% CI 39.4-49.8%), (P=0.07). CONCLUSION: We observed a reduction in 30 day rehospitalization rates among those enrolled in care transitions compared to referent. However, this effect was not sustained at 180 days. More work is needed to identify how the intervention can be sustained beyond 30 days.
BACKGROUND: Care transition programs can potentially reduce 30 day readmission; however, the effect on long-term hospital readmissions is still unclear. OBJECTIVE: We compared short-term (30 day) and long-term (180 day) utilization of participants enrolled in care transitions versus those matched referents eligible but not enrolled. DESIGN: This cohort study was conducted from January 1, 2011 until June 30, 2013 within a primary care academic practice. PARTICIPANTS: Patients at high risk for hospital readmission based on age and comorbid health conditions had participated in care transitions group (cases) or usual care (referent). MAIN MEASURES: The primary outcomes were 30, 90, and 180 day hospital readmissions.. Secondary outcomes included: mortality; emergency room visits and days; combined rehospitalizations and emergency room visits; and total intensive care unit days. Cox proportional hazard models using propensity score matching were used to assess rehospitalization, emergency room visits and mortality. Poisson regression models were used to compare the numbers of hospital days. KEY RESULTS: Compared to referent (n=365), Mayo Clinic Care Transitions patients exhibited a lower 30 day rehospitalization rate compared to referent; 12.4% (95% CI 8.9-15.7) versus 20.1% (95% CI 15.8-24.1%), respectively (P=0.002). At 180-days, there was no difference in rehospitalization between transitions and referent; 39.9% (95% CI 34.6-44.9%) versus 44.8% (95% CI 39.4-49.8%), (P=0.07). CONCLUSION: We observed a reduction in 30 day rehospitalization rates among those enrolled in care transitions compared to referent. However, this effect was not sustained at 180 days. More work is needed to identify how the intervention can be sustained beyond 30 days.
Authors: Bjorg Thorsteinsdottir; Stephanie M Peterson; James M Naessens; Rozalina G Mccoy; Gregory J Hanson; Latonya J Hickson; Christina Yy Chen; Parvez A Rahman; Nilay D Shah; Lynn Borkenhagen; Anupam Chandra; Rachel Havyer; Aaron Leppin; Paul Y Takahashi Journal: J Hosp Med Date: 2019-02-20 Impact factor: 2.960
Authors: Rozalina G McCoy; Stephanie M Peterson; Lynn S Borkenhagen; Paul Y Takahashi; Bjorg Thorsteinsdottir; Anupam Chandra; James M Naessens Journal: Med Care Date: 2018-08 Impact factor: 2.983
Authors: Paul Y Takahashi; Anupam Chandra; Rozalina G McCoy; Lynn S Borkenhagen; Mary E Larson; Bjorg Thorsteinsdottir; Joel A Hickman; Kristi M Swanson; Gregory J Hanson; James M Naessens Journal: J Am Med Dir Assoc Date: 2021-05-11 Impact factor: 4.669
Authors: Steven B Spivack; Darren DeWalt; Jonathan Oberlander; Justin Trogdon; Nilay Shah; Ellen Meara; Morris Weinberger; Kristin Reiter; Devang Agravat; Carrie Colla; Valerie Lewis Journal: J Gen Intern Med Date: 2021-07-13 Impact factor: 6.473
Authors: Paul Y Takahashi; Dawn M Finnie; Stephanie M Quigg; Lynn S Borkenhagen; Ashok Kumbamu; Ashley K Kimeu; Joan M Griffin Journal: Clin Interv Aging Date: 2018-12-19 Impact factor: 4.458
Authors: Erin F Barreto; Heather P May; Diana J Schreier; Laurie A Meade; Brenda K Anderson; Megan E Rensing; Kari L Ruud; Andrea G Kattah; Andrew D Rule; Rozalina G McCoy; Dawn M Finnie; Joseph R Herges; Kianoush B Kashani Journal: Can J Kidney Health Dis Date: 2022-03-06
Authors: Heather Personett May; Abby K Krauter; Dawn M Finnie; Rozalina Grubina McCoy; Kianoush B Kashani; Joan M Griffin; Erin F Barreto Journal: BMJ Open Date: 2022-06-22 Impact factor: 3.006