Dataset Information

Investigating the impact of intervention refusal on hospital readmission.

ABSTRACT: OBJECTIVES:To identify characteristics and readmission risks associated with opting out of a social work-driven transition intervention. STUDY DESIGN:Secondary data analysis of a randomized controlled pilot study at a large nonprofit urban community hospital. METHODS:Hospitalized English-speaking, cognitively intact adults 65 years or older with expected discharge back to the community were eligible for enrollment. Additionally, patients met at least 1 of the 3 criteria: 1) 75 years or older, 2) taking 5 or more medications, or 3) had 1 or more prior inpatient stays or emergency department visits in the previous 6 months. The transition intervention consisted of up to 2 in-home visits (the first occurring within 48 hours after discharge) and up to 4 telephone follow-up calls (for a maximum of 6 total contacts) by a transition social worker. This study analyzed participants randomized to the intervention arm on measures including demographics, medical diagnoses, presence of advance directive, and all-cause 30-day hospital readmissions. RESULTS:Of the 90 patients randomized to the Social Work Intervention Focused on Transitions intervention group, 10% were readmitted within 30 days and nearly one-third refused (ie, opted out of) the home visit component of the intervention. Multivariate analyses revealed that those opting out of the intervention had 3 times greater odds of having a respiratory condition compared with intervention recipients (odds ratio [OR], 3.10; 95% CI, 1.09-8.80; P = .034). Additionally, opting out of the intervention (OR, 6.75; 95% CI, 1.05-43.52; P = .045) and having a diagnosis of cancer (OR, 29.59; 95% CI, 2.01-435.45; P = .014) significantly predicted readmission. CONCLUSIONS:Findings suggest that some at-risk patients may not be receptive to services and programs aimed at improving care transitions, resulting in a higher risk for readmission.

SUBMITTER: Coulourides Kogan A

PROVIDER: S-EPMC5839474 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Investigating the impact of intervention refusal on hospital readmission.

Coulourides Kogan Alexis A Koons Eileen E Enguidanos Susan S

The American journal of managed care 20171201 12

<h4>Objectives</h4>To identify characteristics and readmission risks associated with opting out of a social work-driven transition intervention.<h4>Study design</h4>Secondary data analysis of a randomized controlled pilot study at a large nonprofit urban community hospital.<h4>Methods</h4>Hospitalized English-speaking, cognitively intact adults 65 years or older with expected discharge back to the community were eligible for enrollment. Additionally, patients met at least 1 of the 3 criteria: 1) ...[more]

PMID: 29261248

Similar Datasets

Project description:To isolate hospital effects on risk-standardized hospital-readmission rates, we examined readmission outcomes among patients who had multiple admissions for a similar diagnosis at more than one hospital within a given year.We divided the Centers for Medicare and Medicaid Services hospital-wide readmission measure cohort from July 2014 through June 2015 into two random samples. All the patients in the cohort were Medicare recipients who were at least 65 years of age. We used the first sample to calculate the risk-standardized readmission rate within 30 days for each hospital, and we classified hospitals into performance quartiles, with a lower readmission rate indicating better performance (performance-classification sample). The study sample (identified from the second sample) included patients who had two admissions for similar diagnoses at different hospitals that occurred more than 1 month and less than 1 year apart, and we compared the observed readmission rates among patients who had been admitted to hospitals in different performance quartiles.In the performance-classification sample, the median risk-standardized readmission rate was 15.5% (interquartile range, 15.3 to 15.8). The study sample included 37,508 patients who had two admissions for similar diagnoses at a total of 4272 different hospitals. The observed readmission rate was consistently higher among patients admitted to hospitals in a worse-performing quartile than among those admitted to hospitals in a better-performing quartile, but the only significant difference was observed when the patients were admitted to hospitals in which one was in the best-performing quartile and the other was in the worst-performing quartile (absolute difference in readmission rate, 2.0 percentage points; 95% confidence interval, 0.4 to 3.5; P=0.001).When the same patients were admitted with similar diagnoses to hospitals in the best-performing quartile as compared with the worst-performing quartile of hospital readmission performance, there was a significant difference in rates of readmission within 30 days. The findings suggest that hospital quality contributes in part to readmission rates independent of factors involving patients. (Funded by Yale-New Haven Hospital Center for Outcomes Research and Evaluation and others.).

Dataset Information

Investigating the impact of intervention refusal on hospital readmission.

Publications

Investigating the impact of intervention refusal on hospital readmission.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets