Keane K Lee1,2, Rachel C Thomas2, Thida C Tan2, Thomas K Leong2, Anthony Steimle1, Alan S Go2,3,4. 1. Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, CA (K.K.L., A.S.). 2. Division of Research, Kaiser Permanente Northern California, Oakland, CA (K.K.L., R.C.T., T.C.T., T.K.L., A.S.G.). 3. Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco (A.S.G.). 4. Departments of Medicine, Health Research and Policy, Stanford University, CA (A.S.G.).
Abstract
BACKGROUND: In-person clinic follow-up within 7 days after discharge from a heart failure hospitalization is associated with lower 30-day readmission. However, health systems and patients may find it difficult to complete an early postdischarge clinic visit, especially during the current pandemic. We evaluated the effect on 30-day readmission and death of follow-up within 7 days postdischarge guided by an initial structured nonphysician telephone visit compared with follow-up guided by an initial clinic visit with a physician. METHODS AND RESULTS: We conducted a pragmatic randomized trial in a large integrated healthcare delivery system. Adults being discharged home after hospitalization for heart failure were randomly assigned to either an initial telephone visit with a nurse or pharmacist to guide follow-up or an initial in-person clinic appointment with primary care physicians providing usual care within the first 7 days postdischarge. Telephone appointments included a structured protocol enabling medication titration, laboratory ordering, and booking urgent clinic visits as needed under physician supervision. Outcomes included 30-day readmissions and death and frequency and type of completed follow-up within 7 days of discharge. Among 2091 participants (mean age 78 years, 44% women), there were no significant differences in 30-day heart failure readmission (8.6% telephone, 10.6% clinic, P=0.11), all-cause readmission (18.8% telephone, 20.6% clinic, P=0.30), and all-cause death (4.0% telephone, 4.6% clinic, P=0.49). Completed 7-day follow-up was higher in 1027 patients randomized to telephone follow-up (92%) compared with 1064 patients assigned to physician clinic follow-up (79%, P<0.001). Overall frequency of clinic visits during the first 7 days postdischarge was lower in participants assigned to nonphysician telephone guided follow-up (48%) compared with physician clinic-guided follow-up (77%, P<0.001). CONCLUSIONS: Early, structured telephone follow-up after hospitalization for heart failure can increase 7-day follow-up and reduce in-person visits with comparable 30-day clinical outcomes within an integrated care delivery framework. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03524534.
RCT Entities:
BACKGROUND: In-person clinic follow-up within 7 days after discharge from a heart failure hospitalization is associated with lower 30-day readmission. However, health systems and patients may find it difficult to complete an early postdischarge clinic visit, especially during the current pandemic. We evaluated the effect on 30-day readmission and death of follow-up within 7 days postdischarge guided by an initial structured nonphysician telephone visit compared with follow-up guided by an initial clinic visit with a physician. METHODS AND RESULTS: We conducted a pragmatic randomized trial in a large integrated healthcare delivery system. Adults being discharged home after hospitalization for heart failure were randomly assigned to either an initial telephone visit with a nurse or pharmacist to guide follow-up or an initial in-person clinic appointment with primary care physicians providing usual care within the first 7 days postdischarge. Telephone appointments included a structured protocol enabling medication titration, laboratory ordering, and booking urgent clinic visits as needed under physician supervision. Outcomes included 30-day readmissions and death and frequency and type of completed follow-up within 7 days of discharge. Among 2091 participants (mean age 78 years, 44% women), there were no significant differences in 30-day heart failure readmission (8.6% telephone, 10.6% clinic, P=0.11), all-cause readmission (18.8% telephone, 20.6% clinic, P=0.30), and all-cause death (4.0% telephone, 4.6% clinic, P=0.49). Completed 7-day follow-up was higher in 1027 patients randomized to telephone follow-up (92%) compared with 1064 patients assigned to physician clinic follow-up (79%, P<0.001). Overall frequency of clinic visits during the first 7 days postdischarge was lower in participants assigned to nonphysician telephone guided follow-up (48%) compared with physician clinic-guided follow-up (77%, P<0.001). CONCLUSIONS: Early, structured telephone follow-up after hospitalization for heart failure can increase 7-day follow-up and reduce in-person visits with comparable 30-day clinical outcomes within an integrated care delivery framework. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03524534.
Authors: Austin S Kilaru; Nicholas Illenberger; Zachary F Meisel; Peter W Groeneveld; Manqing Liu; Angira Mondal; Nandita Mitra; Raina M Merchant Journal: Circ Cardiovasc Qual Outcomes Date: 2022-09-08
Authors: Andrea Lázaro Cebas; José Manuel Caro Teller; Carmen García Muñoz; Carlos González Gómez; José Miguel Ferrari Piquero; Carlos Lumbreras Bermejo; José Antonio Romero Garrido; Juana Benedí González Journal: BMC Health Serv Res Date: 2022-02-09 Impact factor: 2.655