Evidence map›Paper›PMID 29181790›Full record

Observational studyJournal of general internal medicine2018

Improving Outcomes After Hospitalization: A Prospective Observational Multicenter Evaluation of Care Coordination Strategies for Reducing 30-Day Readmissions to Maryland Hospitals.

Erik H Hoyer, Daniel J Brotman, Ariella Apfel, Curtis Leung, Romsai T Boonyasai, Melissa Richardson, Diane Lepley, Amy Deutschendorf

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of general internal medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
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  6. Review
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  10. A validated preoperative score for predicting 30-day readmission after 1-2 level elective posterior lumbar fusion.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2019
    Article
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  12. Hospital at Home-Plus: A Platform of Facility-Based Care.Journal of the American Geriatrics Society · 2019
    Article
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  14. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Erik H HoyerDepartment of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA. ehoyer1@jhmi.edu.
Daniel J BrotmanDivision of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
Ariella ApfelDivision of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
Curtis LeungDepartment of Care Coordination and Clinical Resource Management, Johns Hopkins Health System, Baltimore, MD, USA.
Romsai T BoonyasaiDivision of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
Melissa RichardsonDepartment of Care Coordination and Clinical Resource Management, Johns Hopkins Health System, Baltimore, MD, USA.
Diane LepleyDepartment of Care Coordination and Clinical Resource Management, Johns Hopkins Health System, Baltimore, MD, USA.
Amy DeutschendorfDepartment of Care Coordination and Clinical Resource Management, Johns Hopkins Health System, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates.

objectiveTo evaluate the effects of two care coordination interventions on 30-day readmission rates.

designProspective multicenter observational study of hospitalized patients eligible for two care coordination services between January 1, 2013, and October 31, 2015. Readmission rates were compared for patients who received each care coordination intervention versus those who did not using multivariable generalized estimating equation logistic regression models.

participantsA total of 25,628 patients hospitalized in medicine, neurosciences, or surgical sciences units.

interventionsPatients discharged home and deemed to be at high risk for readmission were assigned a nurse Transition Guide (TG) for 30 days post-discharge. All other patients were assigned the Patient Access Line (PAL) intervention, which provided a post-discharge phone call from a registered nurse.

settingTwo large academic hospitals in Baltimore, MD. MAIN MEASURES: Thirty-day all-cause readmission to any Maryland hospital. KEY

resultsAmong all patients, 14.2% (2409/16,993) of those referred for the PAL intervention and 22.8% (1973/8635) of those referred for the TG intervention were readmitted. PAL-referred patients who did not receive the intervention had an adjusted odds ratio (aOR) for readmission of 1.27 (95% confidence interval [95% CI] 1.12-1.44, p < 0.001) compared with patients who did. TG-referred patients who did not receive the TG intervention had an aOR of 1.83 (95% CI 1.60-2.10, p < 0.001) compared with patients who received the intervention. Younger age, male sex, having more comorbidities, and being discharged from a medicine unit were associated with not receiving an assigned intervention. These characteristics were also associated with higher readmission rates.

conclusionsPAL and TG care coordination interventions were associated with lower rates of 30-day readmission. Our findings underscore the importance of determining the appropriate intervention for the hardest-to-reach patients, who are also at the highest risk of being readmitted.

Indexed as

AdultAgedCase-Control StudiesFemaleHumansMaleMarylandMiddle AgedOutcome Assessment, Health CarePatient DischargePatient ReadmissionProspective StudiesQuality Indicators, Health CareRisk Assessment

Identifiers

PMID29181790
PMCPMC5910331

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.