title: Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle.
abstract: BACKGROUND
  Care coordination has shown inconsistent results as a mechanism to reduce hospital readmission and postdischarge emergency department (ED) visit rates.
  
  
  OBJECTIVE
  To assess the impact of a supplemental care bundle targeting high-risk elderly inpatients implemented by hospital-based staff compared to usual care on a composite outcome of hospital readmission and/or ED visitation at 30 and 60 days following discharge.
  
  
  METHODS
  Randomized controlled pilot study in 41 medical inpatients predisposed to unplanned readmission or postdischarge ED visitation, conducted at Baylor University Medical Center. The intervention group care bundle consisted of medication counseling/reconciliation by a clinical pharmacist (CP), condition specific education/enhanced discharge planning by a care coordinator (CC), and phone follow-up.
  
  
  RESULTS
  Groups had similar baseline characteristics. Intervention group readmission/ED visit rates were reduced at 30 days compared to the control group (10.0% versus 38.1%, P = 0.04), but not at 60 days (30.0% versus 42.9%, P = 0.52). For those patients who had a readmission/postdischarge ED visit, the time interval to this event was longer in the intervention group compared to usual care (36.2 versus 15.7 days, P = 0.05). Study power was insufficient to reliably compare the effects of the intervention on lengths of index hospital stay between groups.
  
  
  CONCLUSIONS
  A targeted care bundle delivered to high-risk elderly inpatients decreased unplanned acute health care utilization up to 30 days following discharge. Dissipation of this effect by 60 days postdischarge defines reasonable expectations for analogous hospital-based educational interventions. Further research is needed regarding the impacts of similar care bundles in larger populations across a variety of inpatient settings.
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 North Central Expressway, Dallas, TX 75206, USA..
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Koehler
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Richter
authors.forename: Liz
authors.initials: L
authors.lastname: Youngblood
authors.forename: Brian A
authors.initials: BA
authors.lastname: Cohen
authors.forename: Irving D
authors.initials: ID
authors.lastname: Prengler
authors.forename: Dunlei
authors.initials: D
authors.lastname: Cheng
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Masica
mesh_terms: D000368:Aged; D040561:Assisted Living Facilities / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006299:Health Services for the Aged / Q000592:standards; D006801:Humans; D008297:Male; D006278:Medicare; D010347:Patient Care Planning / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018579:Patient Selection; D010865:Pilot Projects; D011336:Probability; D044469:Racial Groups; D014481:United States