ABSTRACT
BACKGROUND
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.
OBJECTIVE
To determine the effect of receiving a post-discharge telephone call on all-cause 30-day readmission in a general medicine population.
DESIGN
Retrospective observational study.
PARTICIPANTS
Patients discharged home from the Medicine Service at a tertiary care academic medical center between November 2010 and May 2012.
INTERVENTION
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.
KEY RESULTS
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).
CONCLUSIONS
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161–7.
Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345–9.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–28.
Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178–87.
Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281(7):613–20.
Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822–28.
Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The care span: the importance of transitional care in achieving health reform. Health Aff (Millwood). 2011;30(4):746–54.
Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database Syst Rev. 2006; (4):CD004510.
Hansen LO, Greenwald JL, Budnitz T, et al. Project BOOST: effectiveness of a multihospital effort to reduce rehospitalization. J Hosp Med. 2013;8(8):421–7.
Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155(8):520–8.
Harrison PL, Hara PA, Pope JE, Young MC, Rula EY. The impact of post discharge telephonic follow-up on hospital readmission. Popul Health Manag. 2011;14(1):27–32.
Costantino ME, Frey B, Hall B, Painter P. The influence of a post discharge intervention on reducing hospital readmissions in a Medicare population. Popul Health Manag. 2013;16(5):310–6.
Rennke S, Nguyen OK, Shoeb MH, Magan Y, Wachter RM, Ranji SR. Hospital-initiated transitional care interventions as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):433–40.
Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Am J Med. 2001;111(9B):26S–30S.
Bostrom J, Caldwell J, McGuire K, Everson D. Telephone follow-up after discharge from the hospital: does it make a difference? Appl Nurs Res. 1996;9(2):47–52.
Riegel B, Carlson B, Kopp Z, LePetri B, Glaser D, Unger A. Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med. 2002;162(6):705–12.
Jones JS, Young MS, LaFleur RA, Brown MD. Effectiveness of an organized follow-up system for elder patients released from the emergency department. Acad Emerg Med. 1997;4(12):1147–52.
Maynard GA, Budnitz TL, Nickel WK, et al. John M. Eisenberg Patient Safety and Quality Awards. Mentored implementation: building leaders and achieving results through a collaborative improvement model. Innovation in patient safety and quality at the national level. Jt Comm J Qual Patient Saf. 2012;38(7):301–10.
Boonyasai R, Do H, Bracey J, Landis R, Wright S. Characteristics of isolated and serial rehospitalizations suggest a need for different types of improvement strategies [abstract]. J Hosp Med. 2012;7(Suppl 2):513.
Navarro V. Race or class versus race and class. Lancet. 1990;336:1238–40.
Gornick ME, Eggers PW, Reilly TW, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791–9.
Escarce JJ, Puffer FW. Black-white differences in the use of medical care by the elderly. In: Martin LG, Soldo BJ, eds. Racial and ethnic differences in the health of older americans. Washington, DC: National Academy Press; 1997:183–209.
Nicholas J, Gulliford MC. What is a propensity score? Br J Gen Pract. 2008;58:687.
Gayat E, Pirracchio R, Resche-Rigon M, Mebazaa A, Mary J, Porcher R. Propensity scores in intensive care and anaesthesiology literature: a systematic review. Intensive Care Med. 2010;36:1993–2003.
Joyt KE, Jha AK. Thirty-day readmissions—truth and consequences. NEJM. 2012;366:1366–9.
Acknowledgements
Contributors
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.
Funding/Support
This project had no external funding or support
Previous Presentation/Publications
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Harrison, J.D., Auerbach, A.D., Quinn, K. et al. Assessing the Impact of Nurse Post-Discharge Telephone Calls on 30-Day Hospital Readmission Rates. J GEN INTERN MED 29, 1519–1525 (2014). https://doi.org/10.1007/s11606-014-2954-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-014-2954-2