title: Comprehensive Strategies to Reduce Readmissions in Older Patients With Cardiovascular Disease.
abstract: Older adults are frequently readmitted to the hospital soon after hospitalization for common cardiovascular conditions. Yet there are few high-quality data on the best strategies to reduce short-term readmissions because most studies have involved small numbers of participants, single-centre design, and strong susceptibility to bias. Despite these limitations in the literature, a clear signal exists that most studies involving a singular type of intervention, a singular type of health provider, or a low intensity of intervention have failed to reduce readmissions. In contrast, interventions that are most likely to lower readmissions have used comprehensive approaches, including combined hospital and postacute care, multimodal interventions, multidisciplinary teams, or frequent longitudinal contact. Components of a comprehensive approach with the highest level of evidence include high-quality, disease-specific care; multiple transitional care interventions; involvement of multidisciplinary teams; early and frequent outpatient follow-up; and, when possible, home visits. These findings are consistent with data demonstrating that older adults have multiple sources of vulnerability and experience elevated readmission risk from a broad spectrum of medical conditions for an extended time after hospital discharge. Because readmission reduction is difficult and requires new ways of conceptualizing links between inpatient and postacute care, financial incentives may ultimately be required to motivate hospitals and health systems to redesign care processes, deploy new resources, and collaborate with out-of-hospital providers and organizations.
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT and Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA. Electronic address: kumar.dharmarajan@yale.edu.
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003266:Continuity of Patient Care; D006699:Home Care Services; D006761:Hospitals; D006801:Humans; D007297:Inpatients / Q000523:psychology; D000071069:Multiple Chronic Conditions / Q000453:epidemiology; D015279:Organizational Culture; D010348:Patient Care Team; D010359:Patient Readmission; D018802:Patient-Centered Care; D011785:Quality Assurance, Health Care; D013315:Stress, Psychological / Q000517:prevention & control; D019467:Subacute Care; D000069341:Transitional Care