title: A new multimodal geriatric discharge-planning intervention to prevent emergency visits and rehospitalizations of older adults: the optimization of medication in AGEd multicenter randomized controlled trial.
abstract: OBJECTIVE
  To determine whether a new multimodal comprehensive discharge-planning intervention would reduce emergency rehospitalizations or emergency department (ED) visits for very old inpatients.
  
  
  METHODS
  Six-month prospective, randomized (Zelen design), parallel-group, open-label trial.
  
  
  METHODS
  Six acute geriatric units (AGUs) in Paris and its surroundings.
  
  
  METHODS
  Six hundred sixty-five consecutive inpatients aged 70 and older (intervention group (IG) n = 317; control group (CG) n = 348).
  
  
  METHODS
  Intervention-dedicated geriatricians different from those in the study centers implemented the intervention, which targeted three risk factors for preventable readmissions and consisted of three components: comprehensive chronic medication review, education on self-management of disease, and detailed transition-of-care communication with outpatient health professionals.
  
  
  METHODS
  Emergency hospitalization or ED visit 3 and 6 months after discharge, as assessed by telephone calls to the participant, the caregiver, and the general practitioner and confirmed with the hospital administrative database.
  
  
  RESULTS
  Twenty-three percent of IG participants were readmitted to hospital or had an ED visit 3 months after discharge, compared with 30.5% of CG participants (P = .03); at 6 months, the proportions were 35.3% and 40.8%, respectively (P = .15). Event-free survival was significantly higher in the IG at 3 months (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.53-0.97, P = .03) but not at 6 months (HR = 0.81, 95% CI = 0.64-1.04, P = .10).
  
  
  CONCLUSIONS
  This intervention was effective in reducing rehospitalizations and ED visits for very elderly participants 3 but not 6 months after their discharge from the AGU. Future research should investigate the effect of this intervention of transitional care in a larger population and in usual acute and subacute geriatric care.
authors.affiliation: Geriatric Unit, L'Assistance Publique-Hôpitaux de Paris, Paris, France. sylvie.legrain@brt.aphp.fr
authors.forename: Sylvie
authors.initials: S
authors.lastname: Legrain
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.forename: Dominique
authors.initials: D
authors.lastname: Bonnet-Zamponi
authors.forename: Aurélie
authors.initials: A
authors.lastname: Lemaire
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Aquino
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.forename: Elodie
authors.initials: E
authors.lastname: Taillandier-Heriche
authors.forename: Caroline
authors.initials: C
authors.lastname: Thomas
authors.forename: Marc
authors.initials: M
authors.lastname: Verny
authors.forename: Blandine
authors.initials: B
authors.lastname: Pasquet
authors.forename: Aline Lasserre
authors.initials: AL
authors.lastname: Moutet
authors.forename: Déborah
authors.initials: D
authors.lastname: Lieberherr
authors.forename: Sophie
authors.initials: S
authors.lastname: Lacaille
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D018572:Disease-Free Survival; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D010297:Paris; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies