The Enhanced Care Program: Impact of a Care Transition Program on 30-Day Hospital Readmissions for Patients Discharged From an Acute Care Facility to Skilled Nursing Facilities.

Autor: Rosen BT; Cedars-Sinai Health System, Los Angeles, California, USA. RosenB@cshs.org.; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA., Halbert RJ; Cedars-Sinai Health System, Los Angeles, California, USA.; Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA., Hart K; Cedars-Sinai Health System, Los Angeles, California, USA., Diniz MA; Cedars-Sinai Health System, Los Angeles, California, USA., Isonaka S; Cedars-Sinai Health System, Los Angeles, California, USA., Black JT; Cedars-Sinai Health System, Los Angeles, California, USA.
Jazyk: angličtina
Zdroj: Journal of hospital medicine [J Hosp Med] 2018 Apr 01; Vol. 13 (4), pp. 229-236. Date of Electronic Publication: 2017 Oct 04.
DOI: 10.12788/jhm.2852
Abstrakt: Background: Increased acuity of skilled nursing facility (SNF) patients challenges the current system of care for these patients.
Objective: Evaluate the impact on 30-day readmissions of a program designed to enhance the care of patients discharged from an acute care facility to SNFs.
Design: An observational, retrospective cohort analysis of 30-day hospital readmissions for patients discharged to 8 SNFs between January 1, 2014, and June 30, 2015.
Setting: A collaboration between a large, acute care hospital in an urban setting, an interdisciplinary clinical team, 124 community physicians, and 8 SNFs.
Patients: All patients discharged from Cedars-Sinai Medical Center to 8 partner SNFs were eligible for participation.
Intervention: The Enhanced Care Program (ECP) involved the following 3 interventions in addition to standard care: (1) a team of nurse practitioners participating in the care of SNF patients; (2) a pharmacist-driven medication reconciliation at the time of transfer; and (3) educational in-services for SNF nursing staff.
Measurement: Thirty-day readmission rate for ECP patients compared to patients not enrolled in ECP.
Results: The average unadjusted, 30-day readmission rate for ECP patients over the 18-month study period was 17.2% compared to 23.0% among patients not enrolled in ECP (P < 0.001). After adjustment for sociodemographic and clinical characteristics, ECP patients had 29% lower odds of being readmitted within 30 days (P < 0.001). These effects were robust to stratified analyses, analyses adjusted for clustering, and balancing of covariates using propensity weighting.
Conclusions: A coordinated, interdisciplinary team caring for SNF patients can reduce 30-day hospital readmissions.
Databáze: MEDLINE
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