Transitional care for the highest risk patients: findings of a randomised control study.
BACKGROUND
Interventions to prevent readmissions of patients at highest risk have not been rigorously evaluated. We conducted a randomised controlled trial to determine if a post-discharge transitional care programme can reduce readmissions of such patients in Singapore.


METHODS
We randomised 840 patients with two or more unscheduled readmissions in the prior 90 days and Length of stay, Acuity of admission, Comorbidity of patient, Emergency department utilisation score ≥10 to the intervention programme (n = 419) or control (n = 421). Patients allocated to the intervention group received post-discharge surveillance by a multidisciplinary integrated care team and early review in the clinic. The primary outcome was the proportion of patients with at least one unscheduled readmission within 30 days after discharge.


RESULTS
We found no statistically significant reduction in readmissions or emergency department visits in patients on the intervention group compared to usual care. However, patients in the intervention group reported greater patient satisfaction (p < 0.001).


CONCLUSIONS
Any beneficial effect of interventions initiated after discharge is small for high-risk patients with multiple comorbidity and complex care needs. Future transitional care interventions should focus on providing the entire cycle of care for such patients starting from time of admission to final transition to the primary care setting.


BACKGROUND
Clinicaltrials.gov, no NCT02325752.
Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore and Family Medicine, Duke-NUS Graduate Medical School, Singapore.
Kheng Hock
KH
Lee
Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore and Family Medicine, Duke-NUS Graduate Medical School, Singapore.
Lian Leng
LL
Low
Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
John
J
Allen
Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
Sylvaine
S
Barbier
Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore and Family Medicine, Duke-NUS Graduate Medical School, Singapore.
Lee Beng
LB
Ng
Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore and Family Medicine, Duke-NUS Graduate Medical School, Singapore.
Matthew Joo Ming
MJ
Ng
Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore and Family Medicine, Duke-NUS Graduate Medical School, Singapore.
Wei Yi
WY
Tay
Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore.
Shu Yun
SY
Tan
acuity of admission; comorbidity of patient; emergency department utilisation score; integrated care; length of stay; readmissions; transitional care