Assessing the Impact of Nurse Post-Discharge Telephone Calls on 30-Day Hospital Readmission Rates
Several care transition interventions propose that post-discharge phone calls can reduce adverse events and decrease costly return visits to the hospital. However, given the multi-faceted nature of most care transitions interventions, the true relationship between post-discharge phone calls and readmissions in a real world setting is uncertain.
To determine the effect of receiving a post-discharge telephone call on all-cause 30-day readmission in a general medicine population.
Retrospective observational study.
Patients discharged home from the Medicine Service at a tertiary care academic medical center between November 2010 and May 2012.
Patients received two telephone call attempts by a nurse within 72 h of discharge. Nurses followed a standard script to address issues associated with readmission.
MAIN OUTCOME AND MEASURES
Billing data captured readmissions. We used logistic regression-adjusted patient and clinical covariates as well as a propensity score representing likelihood of being called to determine the association between call receipt and risk for readmission.
There were 5,507 eligible patients. In unadjusted analyses, patients who received a call and completed the intervention were significantly less likely to be readmitted compared to those who did not [155 (5.8 %) vs 123 (8.6 %), p < 0.01]. In multivariable models adjusting for socio-demographic and clinical covariates alone, completing a post-discharge telephone call intervention was associated with lower odds for readmission (AOR 0.71; 95 % CI: 0.55–0.91). However, when models adjusted for the likelihood of receiving the phone call using the propensity score, no association between call receipt and readmission was observed (AOR 0.91; 95%CI: 0.69–1.20).
Effectiveness of post-discharge phone call programs may be more related to whether patients are able to answer a phone call than to the care delivered by the phone call. Programs would benefit from improving their ability to perform phone outreach while simultaneously improving on the care delivered during the calls.
KEY WORDSquality improvement readmissions transitions in care
The authors would like to thank UCSF Decision Support analysts Heather Leicester, MSPH and Anna Cho for their help in obtaining phone call data and readmission data, Nurses Nicole Bulloch, RN and Catherine Monetta, RN for their unfailing dedication to our patients and to Deborah Avakian, RN and Susan Alves-Rankin, RN in the Service Excellence Department for their administrative, technical and material support.
This project had no external funding or support
An earlier version of these findings was presented as a poster at the 2013 Society of Hospital Medicine Annual Meeting in Washington, DC.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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