title: Evaluation of a New Zealand program to improve transition of care for older high risk adults.
abstract: Transition interventions aim to improve care and reduce hospital readmissions but evaluations of these interventions have reported inconsistent results. We report on the evaluation of an intervention implemented in Auckland, New Zealand. Participants were people over the age of 65 who had an acute medical admission and were at high risk of readmission. The intervention included an improved discharge process and nurse telephone follow-up soon after discharge. Outcomes were 28 day readmission rates and emergency attendances. The study is observational, using both interrupted times series and regression discontinuity designs. 5239 patients were treated over a one year period. There was no change in readmission rates or ED attendances or secondary outcomes. Not all patients received all components of the intervention. This transition intervention was not successful. Possible reasons for this and implications are discussed. Although non-experimental methods were used, we believe the results are robust.
authors.affiliation: Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Robinson
authors.affiliation: Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Lifeng
authors.initials: L
authors.lastname: Zhou
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.affiliation: Waitemata District Health Board, Auckland, New Zealand.
authors.forename: John Dr
authors.initials: JD
authors.lastname: Scott
authors.affiliation: Waitemata District Health Board, Auckland, New Zealand.|Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Christiansen
authors.affiliation: Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Karen
authors.initials: K
authors.lastname: Holland
authors.affiliation: Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Delwyn E
authors.initials: DE
authors.lastname: Armstrong
authors.affiliation: Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Dale
authors.initials: D
authors.lastname: Bramley
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D006299:Health Services for the Aged / Q000592:standards; D006801:Humans; D008297:Male; D009520:New Zealand; D010351:Patient Discharge / Q000592:standards; D010359:Patient Readmission; D015397:Program Evaluation; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D013997:Time Factors; D000069341:Transitional Care / Q000592:standards
keywords: aged; outcome assessment (health care); patient discharge; patient readmission; telemedicine