 |
|
The Care Transitions Intervention
Results of a Randomized Controlled Trial
Eric A. Coleman, MD, MPH;
Carla Parry, PhD, MSW;
Sandra Chalmers, MPH;
Sung-joon Min, PhD
Arch Intern Med. 2006;166:1822-1828.
Background Patients with complex care needs who require care across different health care settings are vulnerable to experiencing serious quality problems. A care transitions intervention designed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates.
Methods Randomized controlled trial. Between September 1, 2002, and August 31, 2003, patients were identified at the time of hospitalization and were randomized to receive the intervention or usual care. The setting was a large integrated delivery system located in Colorado. Subjects (N = 750) included community-dwelling adults 65 years or older admitted to the study hospital with 1 of 11 selected conditions. Intervention patients received (1) tools to promote cross-site communication, (2) encouragement to take a more active role in their care and to assert their preferences, and (3) continuity across settings and guidance from a "transition coach." Rates of rehospitalization were measured at 30, 90, and 180 days.
Results Intervention patients had lower rehospitalization rates at 30 days (8.3 vs 11.9, P = .048) and at 90 days (16.7 vs 22.5, P = .04) than control subjects. Intervention patients had lower rehospitalization rates for the same condition that precipitated the index hospitalization at 90 days (5.3 vs 9.8, P = .04) and at 180 days (8.6 vs 13.9, P = .046) than controls. The mean hospital costs were lower for intervention patients ($2058) vs controls ($2546) at 180 days (log-transformed P = .049).
Conclusion Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rates of subsequent rehospitalization.
Trial Registration clinicaltrials.gov Identifier: NCT00244491
Author Affiliations: Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Denver.
RELATED ARTICLES
Improving Medication Adherence: Challenges for Physicians, Payers, and Policy Makers
Patrick J. O’Connor
Arch Intern Med. 2006;166(17):1802-1804.
EXTRACT
| FULL TEXT
Cost-Related Medication Nonadherence Among Elderly and Disabled Medicare Beneficiaries: A National Survey 1 Year Before the Medicare Drug Benefit
Stephen B. Soumerai, Marsha Pierre-Jacques, Fang Zhang, Dennis Ross-Degnan, Alyce S. Adams, Jerry Gurwitz, Gerald Adler, and Dana Gelb Safran
Arch Intern Med. 2006;166(17):1829-1835.
ABSTRACT
| FULL TEXT
Effect of Medication Nonadherence on Hospitalization and Mortality Among Patients With Diabetes Mellitus
P. Michael Ho, John S. Rumsfeld, Frederick A. Masoudi, David L. McClure, Mary E. Plomondon, John F. Steiner, and David J. Magid
Arch Intern Med. 2006;166(17):1836-1841.
ABSTRACT
| FULL TEXT
Impact of Medication Therapy Discontinuation on Mortality After Myocardial Infarction
P. Michael Ho, John A. Spertus, Frederick A. Masoudi, Kimberly J. Reid, Eric D. Peterson, David J. Magid, Harlan M. Krumholz, and John S. Rumsfeld
Arch Intern Med. 2006;166(17):1842-1847.
ABSTRACT
| FULL TEXT
Improved Therapeutic Monitoring With Several Interventions: A Randomized Trial
Adrianne C. Feldstein, David H. Smith, Nancy Perrin, Xiuhai Yang, Mary Rix, Marsha A. Raebel, David J. Magid, Steven R. Simon, and Stephen B. Soumerai
Arch Intern Med. 2006;166(17):1848-1854.
ABSTRACT
| FULL TEXT
Physician Communication When Prescribing New Medications
Derjung M. Tarn, John Heritage, Debora A. Paterniti, Ron D. Hays, Richard L. Kravitz, and Neil S. Wenger
Arch Intern Med. 2006;166(17):1855-1862.
ABSTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Coping Difficulties After Hospitalization
Fitzgerald Miller et al.
Clin Nurs Res 2008;17:278-296.
ABSTRACT
Postdischarge Environmental and Socioeconomic Factors and the Likelihood of Early Hospital Readmission Among Community-Dwelling Medicare Beneficiaries
Arbaje et al.
Gerontologist 2008;48:495-504.
ABSTRACT
| FULL TEXT
Seeking What's Best During the Transition to Adult Day Health Services
Bull and McShane
Qual Health Res 2008;18:597-605.
ABSTRACT
Coordinating Care -- A Perilous Journey through the Health Care System
Bodenheimer
NEJM 2008;358:1064-1071.
FULL TEXT
Evidence for Improving Palliative Care at the End of Life: A Systematic Review
Lorenz et al.
ANN INTERN MED 2008;148:147-159.
ABSTRACT
| FULL TEXT
Patterns and predictors of statin use after coronary artery bypass graft surgery.
Kulik et al.
J. Thorac. Cardiovasc. Surg. 2007;134:932-938.
ABSTRACT
| FULL TEXT
Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care
Kripalani et al.
JAMA 2007;297:831-841.
ABSTRACT
| FULL TEXT
Other articles noted
Evid. Based Med. 2007;12:31-32.
FULL TEXT
Improving medication adherence: challenges for physicians, payers, and policy makers.
O'Connor
Arch Intern Med 2006;166:1802-1804.
FULL TEXT
|
