Project ReEngineered Discharge (RED) Lowers Hospital Readmissions of Patients Discharged From a Skilled Nursing Facility

doi:10.1016/j.jamda.2013.03.004

Journal of the American Medical Directors Association

Volume 14, Issue 10, October 2013, Pages 736-740

https://doi.org/10.1016/j.jamda.2013.03.004 Get rights and content

Abstract

Context

Patients admitted to skilled nursing facilities (SNFs) have a high risk for rehospitalization.

Objective

The goal of this project was to implement Project RED in an SNF to increase patient preparedness for care transitions and lower rehospitalization rates in the 30 days after discharge from the SNF facility.

Design

Intervention study with historical control; phone survey 30 days after discharge from the SNF for data collection.

Setting

The study was conducted in an SNF admitting patients from acute care hospitals in Boston, MA.

Patients or Other Participants

A consecutive sample of patients in the SNF before (n = 524) and after initiation (n = 100) of the intervention. Participants had an average age of 80 (SD = 10), 67% were female, and 84% were non-Hispanic white. Phone surveys were completed with 88% of participants in each group.

Intervention(s)

We adapted Project RED for use in an SNF. This includes a comprehensive approach to transitions of care that includes creating and teaching a personalized care plan to patients and their families. Software facilitating these activities was integrated into the electronic medical record of the SNF; intervention activities were delivered by existing staff.

Main Outcome Measure(s)

The main outcome was hospital readmission within 30 days of discharge from the SNF. Secondary outcomes included attendance to a medical appointment within 30 days of discharge from the SNF and preparedness for care transitions as measured by a 6-item survey.

Results

The rate of hospitalization 30 days after discharge from the SNF for participants prior to the intervention was 18.9% and for participants during the intervention was 10.2 %, P < .05. This remained significant adjusting for multiple potential confounders (P = .045). More patients in the intervention group had attended an outpatient appointment within 30 days of discharge (70.5% versus 52.0%, P < .003). In addition, intervention participants reported a higher level of preparedness for care transitions.

Conclusions

Patients in the intervention had a lower rate of returning to the hospital within 30 days of discharge from the SNF, were more likely to attend medical appointments, and were better prepared for their care transition.

Section snippets

Methods

Project RED was adapted for implementation at an SNF by a planning committee composed of a patient who had been discharged from the unit, floor nurses, the medical director of the SNF (R.E.B.), the license administrator for the SNF, the director of nursing, a staff therapist, a dietician, and both social work case managers. The committee sought input from a range of stakeholders, including patient family members, home care nurses and administrators, clergy, and experts in interventions for care

Results

There were 524 participants in the control period and 100 participants in the intervention period; in both groups, 88% were successfully surveyed by phone. Participants had an average age of 80 (SD = 10), 67% were female, and 84% were non-Hispanic white (Table 2). Participants in the intervention period did not differ with respect to age, diabetes, heart failure, or pneumonia with those before the intervention. The rate of chronic lung disease was higher before the intervention and this group

Discussion

Project RED was successfully adapted and implemented in an SNF and lowered the rate of hospitalization within 30 days of discharge from the SNF from 18.9% to 10.2%. Patients reported seeing their outpatient providers more frequently within 30 days of discharge from the SNF. Patients also reported a higher level of preparedness for discharge. This intervention was implemented with existing SNF staff and resulted in a 46% reduction in the number of people being readmitted within 30 days. The

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Post-hospitalization transition interventions remain a priority in preventing rehospitalization. However, not all patients referred for readmission prevention interventions receive them. We sought to 1) define patient characteristics associated with non-receipt of readmission prevention interventions (among those eligible for them), and 2) determine whether these same patient characteristics are associated with hospital readmission at the state level.
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: R.E.B. is the primary investigator and had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. R.E.B., R.S., R.N.J., Z.F., and B.K.I.H. report no financial disclosures or conflicts of interest. The Hebrew SeniorLife Physician-in-Chief fund supported the time of the staff for this improvement project.

: M.K.P.-O. serves as a consultant to Engineered Care, Inc, the exclusive licensee from Boston University of Project RED.

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Original StudyProject ReEngineered Discharge (RED) Lowers Hospital Readmissions of Patients Discharged From a Skilled Nursing Facility

Abstract

Context

Objective

Design

Setting

Patients or Other Participants

Intervention(s)

Main Outcome Measure(s)

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Am Med Dir Assoc

Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities

Arch Intern Med

Rehospitalizations among patients in the Medicare fee-for-service program

N Engl J Med

The revolving door of rehospitalization from skilled nursing facilities

Health Aff (Millwood)

Nursing home characteristics and potentially preventable hospitalizations of long-stay residents

J Am Geriatr Soc

Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs

J Am Geriatr Soc

Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention

J Am Geriatr Soc

Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial

J Am Geriatr Soc

Original Study
Project ReEngineered Discharge (RED) Lowers Hospital Readmissions of Patients Discharged From a Skilled Nursing Facility