A transitional care model for low-income older adults does not reduce readmission rates or emergency department visits during care transitions

2013 ◽  
Vol 17 (3) ◽  
pp. 98-98
Author(s):  
Pamela Nadash
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Transitional Care ◽  
Care Transitions ◽  
Emergency Department Visits ◽  
Care Model ◽  
Readmission Rates

Sex-Specific Clinical Outcomes of the PACT-HF Randomized Trial

2021 ◽  
Author(s):  
Harriette G.C. Van Spall ◽  
Ersilia M. DeFilippis ◽  
Shun Fu Lee ◽  
Urun Erbas Oz ◽  
Richard Perez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Usual Care ◽  
Randomized Trial ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Composite Outcome ◽  
Stepped Wedge ◽  
Care Model ◽  
Care Groups

Background: Transitional care may have different effects in males and females hospitalized for heart failure. We assessed the sex-specific effects of a transitional care model on clinical outcomes following hospitalization for heart failure. Methods: In this stepped-wedge cluster randomized trial of adults hospitalized for heart failure in Ontario, Canada, 10 hospitals were randomized to a group of transitional care services or usual care. Outcomes in this exploratory analysis were composite all-cause readmission, emergency department visit, or death at 6 months; and composite all-cause readmission or emergency department visit at 6 months. Models were adjusted for stepped-wedge design and patient age. Results: Among 2494 adults, mean (SD) age was 77.7 (12.1) years, and 1258 (50.4%) were female. The first composite outcome occurred in 371 (66.3%) versus 433 (64.1%) males (hazard ratio [HR], 1.04 [95% CI, 0.86–1.26]; P =0.67) and in 326 (59.9%) versus 463 (64.8%) females (HR, 0.83 [95% CI, 0.69–1.01]; P =0.06) in the intervention and usual care groups, respectively ( P =0.012 for sex interaction). The second composite outcome occurred in 357 (63.8%) versus 417 (61.7%) males (HR, 1.03 [95% CI, 0.85–1.24]; P =0.76) and 314 (57.7%) versus 450 (63.0%) females (HR, 0.81 [95% CI, 0.67–0.99]; P =0.037) in the intervention and usual care groups, respectively ( P =0.024 for sex interaction). The sex differences were driven by a reduction in all-cause emergency department visits among females (HR, 0.66 [95% CI, 0.51–0.87]; P =0.003), but not males (HR, 1.10 [95% CI, 0.85–1.43]; P =0.46), receiving the intervention ( P <0.001 for sex interaction). Conclusions: A transitional care model offered a reduction in all-cause emergency department visits among females but not males following hospitalization for heart failure. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02112227.

scholarly journals The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing

2021 ◽  
Vol 10 ◽  
pp. 216495612098547
Author(s):  
Jennifer Perloff ◽  
Cindy Parks Thomas ◽  
Eric Macklin ◽  
Peggy Gagnon ◽  
Timothy Tsai ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Tai Chi ◽  
Statistical Significance ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
P Value ◽  
Senior Housing ◽  
The Impact

Background/Objectives This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services. Design Cluster randomized controlled trial with randomization at the housing site level. Setting Greater Boston, Massachusetts. Participants The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition. Intervention Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65. Results The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group. Conclusion ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.

scholarly journals What’s Driving SNF Readmission Rates? Exploring Differences in Processes Between High and Low Performing Hospitals

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 40-40
Author(s):  
Kirstin Manges ◽  
Roman Ayele ◽  
Marcie Lee ◽  
Chelsea Leonard ◽  
Emily Galenbeck ◽  
...  
Keyword(s):  
Older Adults ◽  
Best Practices ◽  
Acute Care ◽  
Transitional Care ◽  
Care Transitions ◽  
Ethnographic Study ◽  
Nursing Facilities ◽  
Readmission Rates ◽  
Care Processes ◽  
Post Acute Care

Abstract Despite the increasing national focus on improving post-acute care outcomes, best practices for reducing readmissions from skilled nursing facilities (SNFs) are unclear. The objective of this rapid ethnographic study was to observe processes used to prepare older patients for post-acute care in SNFs, and to explore differences between hospital-SNF pairs with high or low thirty-day readmission rates. We stratified hospitals according to readmission rates from SNF and used convenience sampling to identify two high and two low performing sites and associated SNFs (n=5). We conducted intensive multi-day observations (n=148 hours) and key informant interviews (n=30 clinicians) to describe hospital processes for discharging patients to SNF. We used thematic analysis of interviews and fieldnotes to identify differences in transitional care processes of hospitals discharging patients to SNFs. Hospitals used five major processes prior to SNF discharge that could affect care transitions for older adults: recognizing the need for post-acute care, deciding level of care, selecting SNF facility, negotiating patient fit, and coordinating care with SNF. During each stage, high-performing sites differed from low-performing sites by focusing on: 1) earlier, ongoing, systematic identification of high-risk patients; 2) discussing the decision to go to a SNF as an iterative team-based process; and 3) anticipating barriers with knowledge of transitional and SNF care processes. Identifying variations in processes used to prepare patients for SNF provides critical insight into the best-practices for transitioning patients to SNFs and areas to target for improving care of older adults.

Reducing emergency department visits among older adults

2019 ◽  
Vol 27 (1) ◽  
pp. 37-49
Author(s):  
Daniel Chen ◽  
Alex M. Torstrick ◽  
Robert Crupi ◽  
Joseph E. Schwartz ◽  
Ira Frankel ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Integrated Care ◽  
Low Income ◽  
Medical Center ◽  
Emergency Department Visits ◽  
Control Group ◽  
Content Type ◽  
Low Intensity ◽  
The Impact

Purpose There is mixed evidence regarding the efficacy of low-intensity integrated care interventions in reducing the use of emergency services and costs of care. The purpose of this paper is to examine the effects of a low-intensity intervention formulated for older adults and delivered in an urban medical center serving low-income individuals. Design/methodology/approach The intervention included an initial evaluation of stress, psychiatric symptomatology and health habits; potential referrals for lifestyle management and psychiatric treatment; and training for physicians about the impact of lifestyle change in older adults. Participants included older adults (at or above 50 years of age) seen as outpatients in an urban medical center serving a low-income community (n=945). Participants were entered into the intervention at any point during this two-year period. Mixed models analyses examined all visits for all enrolled individuals over a two-year period, comparing visits before the individual received the initial intervention evaluation to those received after this evaluation. Outcomes included total health care costs incurred, average cost per visit, and emergency department (ED) usage within the facility. Findings The intervention was associated with reduced likelihood of emergency department use and reduced costs per visit following the intervention. These effects were seen across all participants. Research limitations/implications Limitations of the study include the lack of control group. Practical implications This program is easy to disseminate and could improve the quality of care and costs. Originality/value This study is among the few available to document a decrease in medical costs, as well as decreased ED utilization following a low-intensity integrated care intervention.

scholarly journals Continuity of Care: The Transitional Care Model

2015 ◽  
Vol 20 (3) ◽  
Author(s):  
Karen Hirschman ◽  
Elizabeth Shaid ◽  
Kathleen McCauley ◽  
Mark Pauly ◽  
Mary Naylor
Keyword(s):  
Older Adults ◽  
Transitional Care ◽  
Care Transitions ◽  
Evidence Base ◽  
Management Approach ◽  
Multiple Chronic Conditions ◽  
Care Model ◽  
Healthcare Needs ◽  
Core Components ◽  
Multiple Challenges

Older adults with multiple chronic conditions complicated by other risk factors, such as deficits in activities of daily living or social barriers, experience multiple challenges in managing their healthcare needs, especially during episodes of acute illness. Identifying effective strategies to improve care transitions and outcomes for this population is essential. One rigorously tested model that has consistently demonstrated effectiveness in addressing the needs of this complex population while reducing healthcare costs is the Transitional Care Model (TCM). The TCM is a nurse-led intervention targeting older adults at risk for poor outcomes as they move across healthcare settings and between clinicians. This article provides a detailed summary of the evidence base for the TCM and the model’s nine core components. We also discuss measuring the TCM’s core components and the overall impact of this evidence-based care management approach.

scholarly journals Is Health Information Exchange Use by Hospitals and Home Health Agencies Associated with Lower Readmission Rates?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 914-914
Author(s):  
Christine Jones ◽  
Jacob Thomas ◽  
Marisa Roczen ◽  
Kate Ytell ◽  
Mark Gritz
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Transitional Care ◽  
Care Transitions ◽  
Home Health ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Readmission Rates ◽  
Health Agencies ◽  
Home Health Agencies

Abstract For older adults transitioning from the hospital to home health agencies (HHAs), clinical information exchange is key for optimal transitional care. Hospital and HHA participation in regional health information exchanges (HIEs) could address fragmented communication and improve patient outcomes. We examined differences in characteristics and outcomes for patients with either Medicare or Medicare Advantage (MA) insurance who transitioned from hospitals to HHAs based on HIE participation with 2014-2018 data from the Colorado All Payer Claims Database. We performed analyses including chi square and t tests to compare patient characteristics and 30-day readmission rates for high versus lower HIE use, determined by HIE participation (+) and non-participation (-) among HHAs and hospitals: High HIE use dyads (Hospital+/HHA+) were compared to lower HIE use dyads (Hospital+/HHA-, Hospital-/HHA+, Hospital-/HHA-). We identified 57,998 care transitions from 123 acute care hospitals to 71 HHAs. On average, patients were 75 years old, had a three day hospital length of stay, over half were female (58%), 82% had Medicare and 18% had MA insurance. Although most characteristics were similar between high versus lower HIE use dyads, high HIE use dyads had a higher proportion of Medicare patients compared to the lower HIE use dyads (85% vs 79%, p &lt;0.001). Thirty-day readmissions were 12.4% for care transitions that occurred among high HIE use dyads (n=27,784) compared to 12.8% among lower HIE use dyads (n=32,929, p=0.102). For adults transitioning from hospitals to HHAs among high HIE use dyads, a trend toward lower 30-day readmission rates was identified.

scholarly journals Transitional care models for chronic patients: preliminary results from an umbrella review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M T Riccardi ◽  
M Cicconi ◽  
W Ricciardi ◽  
M M Gianino ◽  
G Damiani
Keyword(s):  
Emergency Department ◽  
Usual Care ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Care Setting ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Current Evidence ◽  
Chronic Patients ◽  
Care Models

Abstract Worldwide, chronic diseases are burdening and the health systems need to be rethought to better manage this epidemiologic shift. One of the critical points in the care pathway of chronic patients is the transition from one care setting to another. Aim of this study is to provide an overview of the current evidence on the impact of transitional care programs on health and economic outcomes for chronic patients Medline, Web of Science and EMBASE were queried for relevant reviews using the Population-Intervention-Context-Outcome (PICO) model. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Data were analyzed using descriptive statistic, and comparison among studies carried out in European Union (EU) versus non-EU was performed (Chi-square test was used and a p &lt; 0.05 was deemed as statistically significant) 124 reviews were assessed for eligibility and 14 were eventually included (for a total of 167 primary articles). Quality appraisal was critically low in 60% of the reviews. Both hospital readmission rate and Emergency Department (ED) visit rate were lower than those in usual care group, but this difference was significant in 40% of articles. In EU studies readmission rate was lower in 65% of cases while in non-EU ones the percentage was 51.0%, but the difference was not significant (p = 0.23). Six reviews (43%) investigated the economic impact of the transitional care: most reported an initial increase in cost due to investment in staff training and creation of organizational networks, followed by a sharp decrease in costs due to a better utilization of health services, thus leading to a reduction in overall costs. Compared with usual care, transitional care shows an overall cost reduction, even if with limited effects on re-hospitalization or ED visit rates. These findings should encourage decision makers to invest in the development of this kind of programs in order to identify models that best perform. Key messages The patient transfer supervision from one care setting to another is necessary for continuity of care, but there is no robust evidence about the better performance of transitional care models. Systematically reviewed transitional care models has been shown be more cost saving, with a moderate impact on hospital readmission or emergency department visits rates.

scholarly journals Head Trauma from Falling Increases Subsequent Emergency Department Visits More Than Other Fall-Related Injuries in Older Adults

2016 ◽  
Vol 64 (4) ◽  
pp. 870-874 ◽  
Author(s):  
Lauren T. Southerland ◽  
Julie A. Stephens ◽  
Shari Robinson ◽  
James Falk ◽  
Laura Phieffer ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Head Trauma ◽  
Emergency Department Visits
Sign in / Sign up

Export Citation Format

Share Document