Nicholas J Cordato1, Mary Kearns2, Peter Smerdely3, Katrin M Seeher4, Matthew D Gardiner5, Henry Brodaty6. 1. Department of Aged Care, St George Hospital, Kogarah, Australia; Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia. Electronic address: nicholas.cordato@health.nsw.gov.au. 2. Department of Aged Care, St George Hospital, Kogarah, Australia. 3. Department of Aged Care, St George Hospital, Kogarah, Australia; Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia. 4. Faculty of Medicine, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia. 5. Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia. 6. Faculty of Medicine, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia. Electronic address: h.brodaty@unsw.edu.au.
Abstract
OBJECTIVES:Rehospitalization of nursing home (NH) residents is frequent, costly, potentially avoidable and associated with diminished quality of life and poor survival. This study aims to evaluate the impact and cost-effectiveness of the Regular Early Assessment Post-Discharge (REAP) protocol of coordinated specialist geriatrician and nurse practitioner visits on rates of rehospitalization, hospital length of stay, and emergency department presentations for NH residents recently discharged from hospital. DESIGN: Prospective randomized controlled study of recently hospitalized NH residents. SETTING:Twenty-one of 24 eligible NHs within the geographical catchment area of St George Hospital, a 650-bed university hospital in Sydney, Australia. PARTICIPANTS: NH residents from eligible facilities admitted to St George Hospital's geriatric service were enrolled prior to hospital discharge. INTERVENTION: REAP intervention of monthly coordinated specialist geriatrician and nurse practitioner assessments within participants' NHs for 6 months following hospital discharge. MEASUREMENTS: Impact of the REAP intervention on hospital readmissions, hospital inpatient days, emergency department utilization, general practitioner visits, investigations and associated costs during the study intervention period. RESULTS:Forty-three NH residents were randomly allocated to REAP intervention (n = 22) or control (n = 21) groups. The REAP intervention group had almost two-thirds fewer hospital readmissions (P = .03; Cohen's d = 0.73) and half as many emergency department visits than controls. Total costs were 50% lower in the REAP intervention group, with lower total hospital inpatient (P = .04; Cohen's d = 0.63) and total emergency department (P = .04; Cohen's d = 0.65) costs. CONCLUSION: Cost-effective reductions in the utilization of hospital-related services were demonstrated following implementation of the REAP intervention for NH residents recently discharged from hospital.
RCT Entities:
OBJECTIVES: Rehospitalization of nursing home (NH) residents is frequent, costly, potentially avoidable and associated with diminished quality of life and poor survival. This study aims to evaluate the impact and cost-effectiveness of the Regular Early Assessment Post-Discharge (REAP) protocol of coordinated specialist geriatrician and nurse practitioner visits on rates of rehospitalization, hospital length of stay, and emergency department presentations for NH residents recently discharged from hospital. DESIGN: Prospective randomized controlled study of recently hospitalized NH residents. SETTING: Twenty-one of 24 eligible NHs within the geographical catchment area of St George Hospital, a 650-bed university hospital in Sydney, Australia. PARTICIPANTS: NH residents from eligible facilities admitted to St George Hospital's geriatric service were enrolled prior to hospital discharge. INTERVENTION: REAP intervention of monthly coordinated specialist geriatrician and nurse practitioner assessments within participants' NHs for 6 months following hospital discharge. MEASUREMENTS: Impact of the REAP intervention on hospital readmissions, hospital inpatient days, emergency department utilization, general practitioner visits, investigations and associated costs during the study intervention period. RESULTS: Forty-three NH residents were randomly allocated to REAP intervention (n = 22) or control (n = 21) groups. The REAP intervention group had almost two-thirds fewer hospital readmissions (P = .03; Cohen's d = 0.73) and half as many emergency department visits than controls. Total costs were 50% lower in the REAP intervention group, with lower total hospital inpatient (P = .04; Cohen's d = 0.63) and total emergency department (P = .04; Cohen's d = 0.65) costs. CONCLUSION: Cost-effective reductions in the utilization of hospital-related services were demonstrated following implementation of the REAP intervention for NH residents recently discharged from hospital.
Authors: Jana Bartakova; Franziska Zúñiga; Raphaëlle-Ashley Guerbaai; Kornelia Basinska; Thekla Brunkert; Michael Simon; Kris Denhaerynck; Sabina De Geest; Nathalie I H Wellens; Christine Serdaly; Reto W Kressig; Andreas Zeller; Lori L Popejoy; Dunja Nicca; Mario Desmedt; Carlo De Pietro Journal: BMC Geriatr Date: 2022-06-09 Impact factor: 4.070
Authors: Kelly Birtwell; Claire Planner; Alexander Hodkinson; Alex Hall; Sally Giles; Stephen Campbell; Natasha Tyler; Maria Panagioti; Gavin Daker-White Journal: JAMA Netw Open Date: 2022-05-02