BACKGROUND: Cardiovascular disease is the most common cause of mortality and hospitalization in the United States. Transitional care initiatives can improve outcomes for cardiac patients, but it is unclear whether patients with different baseline comorbidity burden benefit equally. We evaluated the effectiveness of the Bridging the Discharge Gap Effectively (BRIDGE) program, a nurse-practitioner-led transitional care clinic, in mitigating adverse clinical outcomes in cardiac patients with varying Charlson comorbidity index (CCI). METHODS: We studied patients referred to BRIDGE between 2008 and 2017 postdischarge for a cardiac condition. Using proportional hazards regression models, we evaluated associations between attendance at BRIDGE and hospital readmission, emergency department (ED) visit, and a composite outcome consisting of readmission, ED visit, or mortality, and assessed interaction between BRIDGE attendance and CCI. RESULTS: Of 4559 patients, 3256 (71.4%) attended BRIDGE. In patients with low CCI, attendance at BRIDGE was inversely associated with hospital readmission (adjusted hazard ratio = 0.82, 95% confidence interval [CI]: 0.69, 0.97, P = .02) and the composite endpoint (adjusted hazard ratio = 0.84, 95% CI: 0.72, 0.98, P = .02). Associations of BRIDGE attendance with both readmission and ED visit were significantly weaker in patients with high CCI (adjusted P, interaction = .007 and .03, respectively). Overall, BRIDGE attendance was associated with an 11% lower hazard of developing the composite endpoint (95% CI: 2%, 19%, P = .01). CONCLUSIONS: Attendance at a transitional care clinic is inversely associated with risk of readmission and a composite endpoint in cardiac patients with low CCI. Future research should investigate modified transitional care programs in patients with varying comorbidity burden.
BACKGROUND: Cardiovascular disease is the most common cause of mortality and hospitalization in the United States. Transitional care initiatives can improve outcomes for cardiac patients, but it is unclear whether patients with different baseline comorbidity burden benefit equally. We evaluated the effectiveness of the Bridging the Discharge Gap Effectively (BRIDGE) program, a nurse-practitioner-led transitional care clinic, in mitigating adverse clinical outcomes in cardiac patients with varying Charlson comorbidity index (CCI). METHODS: We studied patients referred to BRIDGE between 2008 and 2017 postdischarge for a cardiac condition. Using proportional hazards regression models, we evaluated associations between attendance at BRIDGE and hospital readmission, emergency department (ED) visit, and a composite outcome consisting of readmission, ED visit, or mortality, and assessed interaction between BRIDGE attendance and CCI. RESULTS: Of 4559 patients, 3256 (71.4%) attended BRIDGE. In patients with low CCI, attendance at BRIDGE was inversely associated with hospital readmission (adjusted hazard ratio = 0.82, 95% confidence interval [CI]: 0.69, 0.97, P = .02) and the composite endpoint (adjusted hazard ratio = 0.84, 95% CI: 0.72, 0.98, P = .02). Associations of BRIDGE attendance with both readmission and ED visit were significantly weaker in patients with high CCI (adjusted P, interaction = .007 and .03, respectively). Overall, BRIDGE attendance was associated with an 11% lower hazard of developing the composite endpoint (95% CI: 2%, 19%, P = .01). CONCLUSIONS: Attendance at a transitional care clinic is inversely associated with risk of readmission and a composite endpoint in cardiac patients with low CCI. Future research should investigate modified transitional care programs in patients with varying comorbidity burden.
Authors: Harriette G C Van Spall; Shun Fu Lee; Feng Xie; Urun Erbas Oz; Richard Perez; Peter R Mitoff; Manish Maingi; Michael C Tjandrawidjaja; Michael Heffernan; Mohammad I Zia; Liane Porepa; Mohamed Panju; Lehana Thabane; Ian D Graham; R Brian Haynes; Dilys Haughton; Kim D Simek; Dennis T Ko; Stuart J Connolly Journal: JAMA Date: 2019-02-26 Impact factor: 56.272
Authors: David T Liss; Ronald T Ackermann; Andrew Cooper; Emily A Finch; Courtney Hurt; Nicola Lancki; Angela Rogers; Avani Sheth; Caroline Teter; Christine Schaeffer Journal: J Gen Intern Med Date: 2019-05-29 Impact factor: 5.128
Authors: Andrew D Auerbach; Sunil Kripalani; Eduard E Vasilevskis; Neil Sehgal; Peter K Lindenauer; Joshua P Metlay; Grant Fletcher; Gregory W Ruhnke; Scott A Flanders; Christopher Kim; Mark V Williams; Larissa Thomas; Vernon Giang; Shoshana J Herzig; Kanan Patel; W John Boscardin; Edmondo J Robinson; Jeffrey L Schnipper Journal: JAMA Intern Med Date: 2016-04 Impact factor: 21.873
Authors: Harlan M Krumholz; Angela Hsieh; Rachel P Dreyer; John Welsh; Nihar R Desai; Kumar Dharmarajan Journal: PLoS One Date: 2016-10-07 Impact factor: 3.240
Authors: Gabriel E Soto; Elizabeth A Huenefeldt; Masey N Hengst; Arlo J Reimer; Shawn K Samuel; Steven K Samuel; Stephen J Utts Journal: BMC Health Serv Res Date: 2018-08-30 Impact factor: 2.655