An effectiveness and cost-benefit analysis of a hospital-based discharge transition program for elderly Medicare recipients.
OBJECTIVE
To investigate the business case of postdischarge care transition (PDCT) among Medicare beneficiaries by conducting a cost-benefit analysis.


METHODS
Randomized controlled trial.


METHODS
A general hospital in upstate New York State.


METHODS
Elderly Medicare beneficiaries being treated from October 2008 through December 2009 were randomly selected to receive services as part of a comprehensive PDCT program (intervention--173 patients) or regular discharge process (control--160 patients) and followed for 12 months.


METHODS
The intervention comprised five activities: development of a patient-centered health record, a structured discharge preparation checklist of critical activities, delivery of patient self-activation and management sessions, follow-up appointments, and coordination of data flow.


METHODS
Cost-benefit ratio of the PDCT program; self-management skills and abilities.


RESULTS
The 1-year readmission analysis revealed that control participants were more likely to be readmitted than intervention participants (58.2% vs 48.2%; P = .08); with most of that difference observed in the 91 to 365 days after discharge. Findings from the cost-benefit analysis revealed a cost-benefit ratio of 1.09, which indicates that, for every $1 spent on the program, a saving of $1.09 was realized. In addition, participating in a care transition program significantly enhanced self-management skills and abilities.


CONCLUSIONS
Postdischarge care transition programs have a dual benefit of enhancing elderly adults' self-management skills and abilities and producing cost savings. This study builds a case for the inclusion of PDCT programs as a reimbursable service in benefit packages.
Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. ss117@aub.edu.lb
Shadi S
SS
Saleh
Chris
C
Freire
Gwendolyn
G
Morris-Dickinson
Trip
T
Shannon
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D009518:New York; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics; D014481:United States