A Randomized Trial of Reducing Readmissions of Patients


For a study, researchers sought to see if post-discharge depression treatment combined with care transition support would benefit hospitalized patients with depressive symptoms. A randomized controlled experiment involving hospitalized patients who scored a 10 or higher on the Patient Health Questionnaire-9. The Re-Engineered Discharge (RED) was implemented. Participants were randomly assigned to receive either RED-only or RED for Depression (RED-D), a 12-week post-discharge telemedicine intervention that included cognitive behavioral therapy, self-management support, and patient navigation. At 30 and 90 days after discharge, the main outcomes were hospital readmission and reutilization rates. A total of 709 people were randomly assigned (353 RED-D, 356 RED-only). At the end of 90 days, 265 (75%) of the intervention participants had undergone at least 1 RED-D session (median 4). At 30 days, there were no differences in hospital readmission (9% vs 10%, incidence rate ratio [IRR] 0.92 [95% CI, 0.56-1.52]) or reutilization between RED-D and RED-only, according to the intention-to-treat analysis (27%vs 24%, IRR 1.14 [95% CI, 0.85-1.54]). There were no differences in readmission (28% vs 21%, IRR 1.30 [95% CI, 0.95-1.78]) or reutilization after 90 days in the intention-to-treat study (70% vs 57%, IRR 1.22 [95% CI, 1.01-1.49]). Each additional RED-D session was linked to a lower 30- and 90-day readmission rate in the as-treated analyses. There were fewer readmissions (3% vs.10%, IRR 0.30 [95% CI, 0.07-0.84]) among 104 patients who received 3 or more sessions at 30 days compared to the control group (3% vs. 10%, IRR 0.30 [95% CI, 0.07-0.84]. There were fewer readmissions at 90 days among 109 people who had 6 or more sessions (11% vs. 21%, IRR 0.52 [95% CI, 0.27-0.92]). On secondary outcomes, an intention-to-treat analysis revealed no differences between study groups. With enough acceptance of the RED-D intervention, care transition support and post-discharge depression treatment can reduce unplanned hospital utilization.

Source:www.annfammed.org/content/20/3/246



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