Support from hospital to home for elders: a randomized trial

Area of Science:

• Health Services Research
• Nursing
• Geriatrics

Background:

• Hospitals aim to reduce readmissions through discharge support programs with varied success.
• Older, diverse patient populations present unique challenges in post-discharge care.
• Safety-net hospitals serve vulnerable populations requiring tailored interventions.

Purpose of the Study:

• To evaluate a nurse-led, peridischarge intervention's effectiveness in reducing emergency department (ED) visits and readmissions.
• To assess the intervention's impact on ethnically and linguistically diverse older patients.
• To determine if enhanced discharge support improves outcomes at a safety-net hospital.

Main Methods:

• A randomized controlled trial (NCT01221532) was conducted at a publicly funded urban hospital.
• Participants included hospitalized adults aged 55+, discharged to the community, speaking English, Spanish, or Chinese.
• The intervention involved in-hospital self-management education and post-discharge telephone follow-up by nurses, compared to usual care.

Main Results:

• The study included 700 low-income, diverse patients (mean age 66.2 years).
• No significant difference in ED visits or readmissions was observed between the intervention and usual care groups at 30, 90, or 180 days.
• Hazard ratios for the primary outcome ranged from 1.11 to 1.26, with wide confidence intervals.

Conclusions:

• The nurse-led discharge support intervention did not reduce readmissions or ED visits in this diverse, low-income older adult population.
• The study may have been underpowered due to fewer outcomes than anticipated.
• Alternative strategies for readmission prevention in this population require investigation.