title: Effectiveness of a discharge planning and community support programme in preventing readmission of high-risk older patients.
abstract: OBJECTIVE
  To examine the effectiveness of Integrated Care and Discharge Support for elderly patients in reducing accident and emergency department attendance, acute hospital admissions, and hospital bed days after discharge. Factors that compromise its effectiveness were investigated and cost analysis was performed.
  
  
  METHODS
  Cohort prospective study.
  
  
  METHODS
  Integrated Care and Discharge Support for elderly patients in Hong Kong West Cluster.
  
  
  METHODS
  Home-dwelling patients recruited between April 2012 and March 2013 into Integrated Care and Discharge Support for elderly patients in Hong Kong West Cluster.
  
  
  RESULTS
  A total of 1090 older patients were studied. The Integrated Care and Discharge Support for elderly patients programme reduced accident and emergency department attendance by 40% (P<0.001), acute hospital admissions by 47% (P<0.001), and hospital bed days by 31% (P<0.001) at 6 months after implementation. Improvements in Barthel Index 20 (P<0.001) and Modified Functional Ambulation Category scale (P<0.001) were observed. Of the patients, 85 (7.8%) died within 6 months of initiation of the programme. Only 26 (2.4%) older patients required institutionalisation in residential care homes within 6 months after the programme. Increasing age (P=0.025) and high Charlson Comorbidity Index score (P=0.001) were positive predictors for accident and emergency department attendance. A high albumin level (P=0.001) and living alone (P=0.033) were negative predictors for accident and emergency department attendance. Of the patients, 310 (28.4%) had no reduction in bed days after the programme. Increasing age (P=0.025) and number of medications (P=0.003) were positive predictors for no reduction in bed days; while higher haemoglobin level (P=0.034) was a negative predictor. There was a potential annual cost-saving of HK$22.5 million (approximately US$2.9 million).
  
  
  CONCLUSIONS
  The Integrated Care and Discharge Support for elderly patients programme reduced accident and emergency department attendance, acute hospital admissions and hospital bed days, and was potentially cost-saving. Age, Charlson Comorbidity Index, albumin level, and living alone were factors associated with accident and emergency department attendance. Age, number of medications, and haemoglobin level were associated with no reduction in bed days. Further study of the cost-effectiveness of such programme is warranted.
authors.affiliation: Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong.
authors.forename: Francis O Y
authors.initials: FO
authors.lastname: Lin
authors.affiliation: Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong.
authors.forename: James K H
authors.initials: JK
authors.lastname: Luk
authors.affiliation: Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong.
authors.forename: T C
authors.initials: TC
authors.lastname: Chan
authors.affiliation: Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong.
authors.forename: Winnie W Y
authors.initials: WW
authors.lastname: Mok
authors.affiliation: Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong.
authors.forename: Felix H W
authors.initials: FH
authors.lastname: Chan
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D019338:Polypharmacy; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin
keywords: Aged; Community health services; Patient discharge