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Early geriatric follow-up visits to nursing home residents reduce the number of readmissions: a quasi-randomised controlled trial

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Abstract

Introduction

Nursing home residents have a high risk of being readmitted after hospitalisation. The objective of this study is to test whether an early geriatric follow-up visit can reduce readmissions among nursing home residents without increasing mortality. The main components of the intervention will also be quantified.

Materials and method

A quasi-randomised controlled design. A population of nursing-home residents aged 75 years or older admitted to hospital with one of nine medical diagnoses. All patients received comprehensive geriatric assessment before discharge. The intervention comprised a visit by a nurse and a doctor from a geriatric team the first weekday after discharge. Control group patients were offered a follow-up visit by their general practitioner 7–14 days after discharge.

Results

Six hundred and forty-eight patients were included in the study between June 1st 2014 and December 15th 2016. In the intervention group, 13% were readmitted within 30 days after discharge, compared to 19% in the control group (p = 0.04). Adjusted hazard ratio = 0.63 (95% CI 0.42–0.95). The median length of hospital stay was 1 day for both groups. Neither 30 nor 90-day mortality were affected by the intervention. The most commonly registered intervention element was direct person-to-person contact between hospital and nursing home staff or relatives, followed by changes in medication and blood tests.

Conclusion

Early geriatric follow-up visits to recently discharged nursing home residents are a safe and effective way of reducing readmissions. Communication, changes in medication, and blood tests were the most frequently performed elements.

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References

  1. Onder G, Liperoti R, Fialova D et al (2012) Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci 67(6):698–704

    Article  PubMed  Google Scholar 

  2. Kiesswetter E, Schrader E, Diekmann R, Sieber C, Volkert D (2015) Varying associations between body mass index and physical and cognitive function in three samples of older adults living in different settings. J Gerontol A Biol Sci Med Sci 70(10):1255–1261

    Article  PubMed  Google Scholar 

  3. Buntinx F, Niclaes L, Suetens C, Jans B, Mertens R, Van den Akker M (2002) Evaluation of Charlson’s comorbidity index in elderly living in nursing homes. J Clin Epidemiol 55(11):1144–1147

    Article  PubMed  CAS  Google Scholar 

  4. Silverstein MD, Qin H, Mercer SQ, Fong J, Haydar Z (2008) Risk factors for 30-day hospital readmission in patients ≥ 65 years of age. Proc Bayl Univ Med Cent 21(4):363–372

    Article  PubMed  PubMed Central  Google Scholar 

  5. Quinn T (2011) Emergency hospital admissions from care-homes: who, why and what happens? A cross-sectional study. Gerontology 57(2):115–120

    Article  PubMed  Google Scholar 

  6. Zanocchi M, Maero B, Martinelli E et al (2006) Early re-hospitalization of elderly people discharged from a geriatric ward. Aging Clin Exp Res 18(1):63–69

    Article  PubMed  Google Scholar 

  7. Bogaisky M, Dezieck L (2015) Early hospital readmission of nursing home residents and community-dwelling elderly adults discharged from the geriatrics service of an urban teaching hospital: patterns and risk factors. J Am Geriatr Soc 63(3):548–552

    Article  PubMed  Google Scholar 

  8. Tang VL, Halm EA, Fine MJ, Johnson CS, Anzueto A, Mortensen EM (2014) Predictors of rehospitalization after admission for pneumonia in the veterans affairs healthcare system. J Hosp Med 9(6):379–383

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hakkarainen TW, Arbabi S, Willis MM, Davidson GH, Flum DR (2016) Outcomes of patients discharged to skilled nursing facilities after acute care hospitalizations. Ann Surg 263(2):280–285

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ouslander JG, Naharci I, Engstrom G et al (2016) Hospital transfers of skilled nursing facility (SNF) patients within 48 h and 30 days after SNF admission. J Am Med Dir Assoc. 17(9):839–845

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mor V, Intrator O, Feng Z, Grabowski DC (2010) The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood) 29(1):57–64

    Article  Google Scholar 

  12. Wang HE, Shah MN, Allman RM, Kilgore M (2011) Emergency department visits by nursing home residents in the united states. J Am Geriatr Soc 59(10):1864–1872

    Article  PubMed  PubMed Central  Google Scholar 

  13. Dwyer R, Gabbe B, Stoelwinder JU, Lowthian J (2014) A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities. Age Ageing 43(6):759–766

    Article  PubMed  Google Scholar 

  14. Mudge AM, Denaro CP, O’Rourke P (2012) Improving hospital outcomes in patients admitted from residential aged care: results from a controlled trial. Age Ageing 41(5):670–673

    Article  PubMed  Google Scholar 

  15. King BJ, Gilmore-Bykovskyi AL, Roiland RA, Polnaszek BE, Bowers BJ, Kind AJ (2013) The consequences of poor communication during transitions from hospital to skilled nursing facility: a qualitative study. J Am Geriatr Soc 61(7):1095–1102

    Article  PubMed  Google Scholar 

  16. Terrell KM, Miller DK (2006) Challenges in transitional care between nursing homes and emergency departments. J Am Med Dir Assoc 7(8):499–505

    Article  PubMed  Google Scholar 

  17. Sandvik D, Bade P, Dunham A, Hendrickson S (2013) A hospital-to-nursing home transfer process associated with low hospital readmission rates while targeting quality of care, patient safety, and convenience: a 20-year perspective. J Am Med Dir Assoc 14(5):367–374

    Article  PubMed  Google Scholar 

  18. Ouslander JG, Bonner A, Herndon L, Shutes J (2014) The interventions to reduce acute care transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care. J Am Med Dir Assoc 15(3):162–170

    Article  PubMed  PubMed Central  Google Scholar 

  19. Deniger A, Troller P (2014) Geriatric transitional care and readmissions review. J Am Geriatr Soc 62:S221

    Google Scholar 

  20. Coleman EA, Parry C, Chalmers S, Min SJ (2006) The care transitions intervention: results of a randomised controlled trial. Arch Intern Med 166(17):1822–1828

    Article  PubMed  Google Scholar 

  21. Buurman BM, Parlevliet JL, Allore HG et al (2016) Comprehensive geriatric assessment and transitional care in acutely hospitalized patients: the transitional care bridge randomised clinical trial. JAMA Intern Med 176(3):302–309

    Article  PubMed  Google Scholar 

  22. Watkins L, Hall C, Kring D (2012) Hospital to home: A transition program for frail older adults. Prof Case Manag 17(3):117–123 (quiz 124–5)

    Article  PubMed  Google Scholar 

  23. Edmans J, Bradshaw L, Franklin M, Gladman J, Conroy S (2013) Specialist geriatric medical assessment for patients discharged from hospital acute assessment units: randomised controlled trial. BMJ 347:f5874

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pedersen LH, Gregersen M, Barat I, Damsgaard EM (2017) Early geriatric follow-up after discharge reduces mortality among patients living in their own home. A randomised controlled trial. Eur Geriatr Med 8(4):330–336

    Article  Google Scholar 

  25. Pedersen LH, Gregersen M, Barat I, Damsgaard EM (2016) Early geriatric follow-up after discharge reduces readmissions? A quasi-randomised controlled trial. Eur Geriatr Med 7(5):443–448

    Article  Google Scholar 

  26. Gregersen M, Zintchouk D, Borris LC, Damsgaard EM (2011) A geriatric multidisciplinary and tailor-made hospital-at-home method in nursing home residents with hip fracture. Geriatr Orthop Surg Rehabil 2(4):148–154

    Article  PubMed  PubMed Central  Google Scholar 

  27. Harvey P, Storer M, Berlowitz DJ, Jackson B, Hutchinson A, Lim WK (2014) Feasibility and impact of a post-discharge geriatric evaluation and management service for patients from residential care: The residential care intervention program in the elderly (RECIPE). BMC Geriatr 14:48

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ouslander JG, Naharci I, Engstrom G et al (2016) Root cause analyses of transfers of skilled nursing facility patients to acute hospitals: lessons learned for reducing unnecessary hospitalizations. J Am Med Dir Assoc 17(3):256–262

    Article  PubMed  Google Scholar 

  29. Caplan GA, Meller A, Squires B, Chan S, Willett W (2006) Advance care planning and hospital in the nursing home. Age Ageing 35(6):581–585

    Article  PubMed  Google Scholar 

  30. Should Dosa D (2006) I hospitalize my resident with nursing home-acquired pneumonia? J Am Med Dir Assoc 74–80:73

    Google Scholar 

  31. Lau L, Chong CP, Lim WK (2013) Hospital treatment in residential care facilities is a viable alternative to hospital admission for selected patients. Geriatr Gerontol Int 13(2):378–383

    Article  PubMed  Google Scholar 

  32. Caplan GA, Sulaiman NS, Mangin DA, Aimonino Ricauda N, Wilson AD, Barclay L (2012) A meta-analysis of “hospital in the home”. Med J Aust 197(9):512–519

    Article  PubMed  Google Scholar 

  33. Boockvar KS, Gruber-Baldini AL, Burton L, Zimmerman S, May C, Magaziner J (2005) Outcomes of infection in nursing home residents with and without early hospital transfer. J Am Geriatr Soc 53(4):590–596

    Article  PubMed  Google Scholar 

  34. Shepperd S, Iliffe S, Doll Helen A, et al. (2016) Admission avoidance hospital at home. Cochrane Database of Systematic Reviews issue 9. CD007491

  35. Goncalves-Bradley, Daniela C, Iliffe, et al. (2017) Early discharge hospital at home. Cochrane Database of Systematic Reviews issue 6. CD000356 

  36. Covinsky KE, Pierluissi E, Johnston CB (2011) Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure”. JAMA 306(16):1782–1793

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Lene Holst Pedersen, Merete Gregersen & Else Marie Damsgaard

  2. The Regional Hospital in Horsens, Sundvej 30, 8700, Horsens, Denmark

    Ishay Barat

Authors
  1. Lene Holst Pedersen
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  2. Merete Gregersen
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  3. Ishay Barat
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  4. Else Marie Damsgaard
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Corresponding author

Correspondence to Lene Holst Pedersen.

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Conflict of interest

There was no conflict of interest.

Ethical approval

The study was reviewed by The Ethical Committee in The Central Denmark Region and was performed in accordance to the ethical standards of the Helsinki declaration.

Informed consent

The Ethical committee approved that patients did not sign a consent form, because of the organizational design. However, patients could decline to participate in the study at any time.

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Pedersen, L.H., Gregersen, M., Barat, I. et al. Early geriatric follow-up visits to nursing home residents reduce the number of readmissions: a quasi-randomised controlled trial. Eur Geriatr Med 9, 329–337 (2018). https://doi.org/10.1007/s41999-018-0045-3

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  • DOI: https://doi.org/10.1007/s41999-018-0045-3

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