title: A randomized-controlled trial of a patient-centred intervention in high-risk discharged older patients.
abstract: BACKGROUND
  The risk of early reattendance after discharge has been proposed as a performance indicator for emergency departments (EDs), but is not uniform in all patients. Those individuals at the highest risk of reattendance may benefit from an intense intervention to reduce this risk, and our objective was to test this hypothesis in a clinical trial.
  
  
  METHODS
  A randomized-controlled trial was conducted in the EDs of two hospitals. Very high-risk adults aged 65 years and older, identified using a validated risk-prediction nomogram and being discharged from ED, were randomized to receive a postdischarge patient-centred intervention or standard care. The intervention focused on identifying and supporting patients to address risk factors for future hospital presentation. The primary outcome measure was any unplanned ED reattendance within 28 days. Secondary outcomes included 28-day and 1-year hospital usage, institutionalization and death.
  
  
  RESULTS
  We enrolled 164 patients, 82 in each study arm. There was an 8% absolute (95% confidence interval: -7%-20%) and a 20% relative risk reduction for an intervention patient making an unplanned ED reattendance within 28 days. This difference was not statistically significant (P=0.26).
  
  
  CONCLUSIONS
  This postdischarge intervention was associated with only small and nonsignificant reductions in ED reattendance.
authors.affiliation: Faculty of Medicine, University of Western Australia.|Clinical Sciences, Harry Perkins Institute of Medical Research, Nedlands, Western Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Arendts
authors.affiliation: South Metropolitan Health Service.
authors.forename: Kate
authors.initials: K
authors.lastname: Bullow
authors.affiliation: Faculty of Medicine, University of Western Australia.|Clinical Sciences, Harry Perkins Institute of Medical Research, Nedlands, Western Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Etherton-Beer
authors.affiliation: Royal Perth Hospital, Perth.
authors.forename: Ellen
authors.initials: E
authors.lastname: MacDonald
authors.affiliation: South Metropolitan Health Service.
authors.forename: Sandra
authors.initials: S
authors.lastname: Dumas
authors.affiliation: South Metropolitan Health Service.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Nagree
authors.affiliation: Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Simon G A
authors.initials: SGA
authors.lastname: Brown
authors.affiliation: Faculty of Medicine, University of Western Australia.|Clinical Sciences, Harry Perkins Institute of Medical Research, Nedlands, Western Australia.
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003422:Critical Care / Q000458:organization & administration; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000458:organization & administration*; D016019:Survival Analysis; D014904:Western Australia