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  • Title: A multidisciplinary intervention for reducing readmissions among older adults in a patient-centered medical home.
    Author: Stranges PM, Marshall VD, Walker PC, Hall KE, Griffith DK, Remington T.
    Journal: Am J Manag Care; 2015 Feb; 21(2):106-13. PubMed ID: 25880360.
    Abstract:
    OBJECTIVES: To evaluate the effectiveness of a multidisciplinary practice model consisting of medical providers, clinical pharmacists, and social workers on reducing 30-day all-cause readmissions. STUDY DESIGN: Retrospective cohort study. METHODS: This study included adults 60 years or older discharged from a large academic medical center. Patients were grouped as either receiving the primary care-based transitional care program (intervention group) or usual care (control group) after an index hospitalization. Only 1 index hospitalization was included per patient. All-cause 30-day readmission rates between propensity score matched study groups were analyzed by intention-to-treat, per protocol, and as-treated methods. Secondary outcomes included time to readmission, subgroup analysis, process measures, and cost avoidance influence of covariates on chance of readmission measured by logistic regression. RESULTS: Over 27 months, 19,169 unique patients had 18,668 index hospitalizations and 572 interventions scheduled after discharge. Among matched subjects, 30-day readmission rates were not significantly different between those scheduled for the intervention and those never scheduled (21% vs 17.3%, respectively; P = .133). However, when those completing the intervention (n = 217) were examined, readmission rates were significantly reduced (11.7% vs 17.3%, respectively; P < .001). Likewise, time to readmission was significantly longer among those receiving the intervention (18 ± 9 days compared with 12 ± 9 days with usual care; P = .015) and potential cost avoidance was observed only when the intervention was completed. CONCLUSIONS: A community-based multidisciplinary transitional care program may reduce hospital readmissions among older adults.
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