title: A comprehensive hospital-based intervention to reduce readmissions for chronically ill patients: a randomized controlled trial.
abstract: OBJECTIVE
  Medicare penalizes hospitals with 30-day readmissions above their expected rates. Hospitals have responded by implementing transitional care interventions; however, there is limited evidence to inform the development of a successful intervention.
  
  
  METHODS
  Parallel-group, stratified, randomized controlled trial.
  
  
  METHODS
  A total of 512 patients hospitalized at 2 community hospitals, with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), were randomly assigned to the intervention (n = 253) or usual care (n = 259). The intervention encompassed a 90-day hospital-based transitional care program. The primary end points were 30- and 90-day all-cause readmissions. Secondary measures included all-cause emergency department (ED) visits and mortality.
  
  
  RESULTS
  On average, study participants were 67 years of age, 57% female, and 70% insured by Medicare. There was no statistical difference between treatment groups on 30-day readmission incidence rates (difference, 0.040; 95% CI, -0.047 to 0.127; P = .36), or 90-day readmission incidence rates (difference of 0.035; 95% CI -0.122 to 0.192; P = .66). Groups also did not differ in ED visit incidence rates at 30 or 90 days. The mortality rate among patients with CHF showed no difference between groups (risk ratio = 0.90; 95% CI, 0.40-2.05). However, for COPD, mortality at 90 days was lower in the intervention group than in the usual care group (risk ratio = 0.28; 95% CI, 0.10-0.83).
  
  
  CONCLUSIONS
  Stand-alone community hospitals may be unable to prevent readmissions despite the use of comprehensive, evidence-based intervention components that are within their control. Better collaboration between hospitals and community-based providers is needed to ensure continuity of care for discharged patients.
  
  
  BACKGROUND
  ClinicalTrials.gov, Identifier: NCT01855022.
authors.affiliation: Linden Consulting Group, LLC, 1301 N Bay Dr, Ann Arbor, MI 48103. E-mail: alinden@lindenconsulting.org.
authors.forename: Ariel
authors.initials: A
authors.lastname: Linden
authors.forename: Susan
authors.initials: S
authors.lastname: Butterworth
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006764:Hospitals, Community / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D062405:Motivational Interviewing / Q000379:methods; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000628:therapy*; D000069341:Transitional Care / Q000458:organization & administration; D016903:Drug Monitoring