title: Prioritized post-discharge telephonic outreach reduces hospital readmissions for select high-risk patients.
abstract: OBJECTIVE
  To determine if post-discharge telephonic case management (CM) reduces emergent hospital readmissions for select high-risk patients.
  
  
  METHODS
  Prospective, randomized.
  
  
  METHODS
  We conducted a prospective, randomized control study of the effect of hospital discharge planning from health plan telephonic case managers on readmissions for high-risk patients. High risk was defined as having an initial discharge major diagnosis of gastrointestinal, heart, or lower respiratory and length of stay of 3 days or more. The intervention group (N = 1994) received telephonic outreach and engagement within 24 hours of discharge and their calls were made in descending risk order to engage the highest risk first. The control group (N = 1994) received delayed telephonic outreach and engagement 48 hours after discharge notification and no call order by risk was applied. Comparison groups had statistically equivalent characteristics at baseline (P > .05).
  
  
  RESULTS
  The intent-to-treat 60-day readmission rate for the treatment group was 7.4% versus 9.6% for the control group (P = .01), representing a 22% relative reduction in all-cause readmissions. Two post hoc assessments were conducted to identify potential mechanisms of action for this effect and showed that the treatment group had more physician visits and prescription drug fills following initial discharge.
  
  
  CONCLUSIONS
  Telephonic CM reduces the likelihood of 60-day readmissions for select high-risk patients. This study suggests that prioritizing telephonic outreach to a select group of highrisk patients based on their discharge date and risk severity is an effective case management strategy. Future studies should explore patients' activity beyond phone calls to further explain the mechanism for readmission reduction.
authors.affiliation: CIGNA HealthCare, Raleigh, NC, USA. Larry.Melton@CIGNA.com
authors.forename: L Doug
authors.initials: LD
authors.lastname: Melton
authors.forename: Charles
authors.initials: C
authors.lastname: Foreman
authors.forename: Eileen
authors.initials: E
authors.lastname: Scott
authors.forename: Matthew
authors.initials: M
authors.lastname: McGinnis
authors.forename: Michael
authors.initials: M
authors.lastname: Cousins
mesh_terms: D000367:Age Factors; D019090:Case Management / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012723:Sex; D013689:Telephone