A Nurse-Led Bridging Program to Reduce 30-Day Readmissions of Older Patients Discharged From Acute Care Units

Autor: Thomas, Gilbert, Pauline, Occelli, Muriel, Rabilloud, Stéphanie, Poupon-Bourdy, Benjamin, Riche, Sandrine, Touzet, Marc, Bonnefoy, Antoine, Vignoles
Přispěvatelé: Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Université de Lyon, Hospices Civils de Lyon (HCL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), PROUST Study Group: Michel Chuzeville, Brigitte Comte, Cyrille Colin, André Dartiguepeyrou, Matthieu Debray, Gwen Grguric, Max Haine, Marine Haution, Thierry Jacquet-Francillon, Christell Julien, Jean-Stéphane Luiggi, Géraldine Martin-Gaujard, Anne-Marie Schott, Magali Tardy, Basile Turkie, Claire Vanhaecke-Collard, Antoine Vignoles, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CarMeN, laboratoire
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Journal of the American Medical Directors Association
Journal of the American Medical Directors Association, Elsevier, 2020, 22 (6), pp.1292-1299. ⟨10.1016/j.jamda.2020.09.015⟩
Journal of the American Medical Directors Association, 2020, 22 (6), pp.1292-1299. ⟨10.1016/j.jamda.2020.09.015⟩
ISSN: 1525-8610
DOI: 10.1016/j.jamda.2020.09.015⟩
Popis: International audience; OBJECTIVES: Older hospitalized patients are at high risk of early readmissions, requiring the implementation of enhanced coordinated transition programs on discharge. The objective of this study was to evaluate the impact of a nurse-led transition bridging program on the rate of unscheduled readmissions of older patients within 30 days from discharge from geriatric acute care units. DESIGN: A stepped-wedge cluster randomized trial. SETTING AND PARTICIPANTS: Seven hundred five patients aged ≥75 years hospitalized in one of 10 acute geriatric units, with at least 2 readmission risk-screening criteria (derived from the Triage Risk Screening Tool), were included from July 2015 to August 2016. METHODS: The intervention condition consisted in a nurse-led hospital-to-home bridging program with 4 weeks postdischarge follow-up (2 home visits and 2 telephone calls). Unscheduled hospital readmission or emergency department (ED) visits were compared in intervention and control condition within 30 days from discharge. RESULTS: The rate of 30-day readmission or ED visit was 15.5% in the intervention condition vs 17.6% in the control condition [hazard ratio stratified on clusters: 0.61 (upper limit unilateral 95% confidence interval = 1.11), P = .09]. Rate of presence of professional caregivers was increased in the intervention condition (P \textless .001). CONCLUSIONS AND IMPLICATIONS: Although the intervention resulted in an increase in the rate of implementation of a package of care at the 4-week of follow-up, we could not demonstrate a reduction in the rate of 30-day readmissions or ED visits of older patients at risk of readmission. These findings support the evaluation of this type of program on the longer term.
Databáze: OpenAIRE
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