title: Aiming to Improve Readmissions Through InteGrated Hospital Transitions (AIRTIGHT): study protocol for a randomized controlled trial.
abstract: Hospital readmissions remain highly prevalent despite being the target of policies and financial penalties. Evidence comparing the effectiveness and costs of interventions to reduce readmissions is lacking, leaving healthcare systems with little guidance on how to improve quality and avoid costly penalties. Effective interventions likely need to bridge inpatient and outpatient settings, incorporate information technology, and use dedicated providers. Such complex innovations will require rigorous evaluation. The framework of quality improvement research provides an approach that both improves care locally and contributes to closing the current knowledge gaps for readmissions. In this trial, we will study a comprehensive intervention that incorporates these recommendations into an integrated practice unit, called transition services, with an aim of reducing 30-day readmission rates.
  
  
  
  We describe a nonblinded, pragmatic, controlled trial with two parallel groups comprising an evaluation of the effect of referral to a provider-led integrated practice unit, inclusive of comprehensive multidisciplinary care, dedicated paramedicine providers, and virtual visits, on 30-day readmission rates for high-risk hospitalized patients. An automated risk-scoring system will randomly generate referrals to either transition services or usual care for 1520 hospitalized patients who score as high-risk for readmission. Transition services will then engage with patients in the hospital setting using a patient navigator and provide bridging outpatient services for the 30 days following discharge. All outcome data are retrieved electronically from administrative medical records. After reapplication of inclusion and exclusion criteria at the time of hospital discharge, analyses will follow the intention-to-treat principle such that patients will be analyzed on the basis of the referral group to which they were initially randomized.
  
  
  
  The hospital transition program under study is complex and integrates the latest recommendations for readmission reduction strategies. As healthcare systems innovate to address readmissions through such complex interventions, there is significant benefit for stakeholders to have a clear understanding of the potential reach, cost, and real-world effectiveness. The pragmatic methods described here provide a template for conducting quality improvement research that fits seamlessly into existing care delivery and improvement efforts, leading to better-informed strategic decisions and the investments necessary to transform care and value for patients.
  
  
  
  ClinicalTrials.gov, NCT02763202 . Registered 3 March 2016 (retrospectively registered).
authors.affiliation: Center for Outcomes Research and Evaluation, Carolinas HealthCare System, 1540 Garden Terrace, Charlotte, NC, 28203, USA. andrew.mcwilliams@carolinashealthcare.org.|Carolinas Hospitalist Group, Carolinas HealthCare System, 801 East Boulevard, Charlotte, NC, 28203, USA. andrew.mcwilliams@carolinashealthcare.org.
authors.forename: Andrew
authors.identifier: 0000-0002-8397-3531
authors.initials: A
authors.lastname: McWilliams
authors.affiliation: Dickson Advanced Analytics, Carolinas HealthCare System, 720 East Morehead Street, Suite 202, Charlotte, NC, 28202, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Roberge
authors.affiliation: Center for Outcomes Research and Evaluation, Carolinas HealthCare System, 1540 Garden Terrace, Charlotte, NC, 28203, USA.
authors.forename: Charity G
authors.initials: CG
authors.lastname: Moore
authors.affiliation: Dickson Advanced Analytics, Carolinas HealthCare System, 720 East Morehead Street, Suite 202, Charlotte, NC, 28202, USA.
authors.forename: Avery
authors.initials: A
authors.lastname: Ashby
authors.affiliation: Center for Outcomes Research and Evaluation, Carolinas HealthCare System, 1540 Garden Terrace, Charlotte, NC, 28203, USA.
authors.forename: Whitney
authors.initials: W
authors.lastname: Rossman
authors.affiliation: Carolinas Hospitalist Group, Carolinas HealthCare System, 801 East Boulevard, Charlotte, NC, 28203, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Murphy
authors.affiliation: Carolinas Hospitalist Group, Carolinas HealthCare System, 801 East Boulevard, Charlotte, NC, 28203, USA.
authors.forename: Stephannie
authors.initials: S
authors.lastname: McCall
authors.affiliation: Carolinas Hospitalist Group, Carolinas HealthCare System, 801 East Boulevard, Charlotte, NC, 28203, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Brown
authors.affiliation: Medical Group Acute Care Division, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Carpenter
authors.affiliation: Medical Group Acute Care Division, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Rissmiller
authors.affiliation: Department Internal Medicine, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Furney
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards; D006801:Humans; D009657:North Carolina; D010348:Patient Care Team; D010359:Patient Readmission / Q000592:standards; D010360:Patient Transfer / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D015397:Program Evaluation; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012107:Research Design; D012307:Risk Factors; D013997:Time Factors