Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 May;62(5):865-71.
doi: 10.1111/jgs.12798. Epub 2014 Apr 29.

An electronic health record-based intervention to increase follow-up office visits and decrease rehospitalization in older adults

Jerry H Gurwitz  1 , Terry S Field, Jessica Ogarek, Jennifer Tjia, Sarah L Cutrona, Leslie R Harrold, Shawn J Gagne, Peggy Preusse, Jennifer L Donovan, Abir O Kanaan, George Reed, Lawrence Garber
Affiliations
Randomized Controlled Trial

An electronic health record-based intervention to increase follow-up office visits and decrease rehospitalization in older adults

Jerry H Gurwitz et al. J Am Geriatr Soc. 2014 May.

Abstract

Objectives: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.

Design: Randomized controlled trial.

Setting: Large multispecialty group practice.

Participants: Individuals aged 65 and older discharged from hospital to home.

Intervention: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule a posthospitalization office visit.

Measurements: An outpatient office visit with a primary care provider after discharge and rehospitalization within 30 days after discharge.

Results: Of the 1,870 discharges in the intervention group, 27.7% had an office visit with a primary care provider within 7 days of discharge. Of the 1,791 discharges in the control group, 28.3% had an office visit with a primary care provider within 7 days of discharge. In the intervention group, 18.8% experienced a rehospitalization within the 30-day period after discharge, compared with 19.9% in the control group. The hazard ratio for an office visit with a primary care physician did not significantly differ between the intervention and control groups. The hazard ratio for rehospitalization in the 30-day period after hospital discharge in the intervention versus the control group was 0.94 (95% confidence interval = 0.81-1.1).

Conclusion: This electronic health record-based intervention did not have a significant effect on the timeliness of office visits to primary care providers after hospitalization or risk of rehospitalization.

Keywords: care transitions; randomized controlled trial; readmission; rehospitalization; safety.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Adapted CONSORT Flow Diagram
Figure 2
Figure 2
Kaplan-Meier estimates of time to an office visit with a primary care physician.
Figure 3
Figure 3
Kaplan-Meier estimates of time to rehospitalization.
See this image and copyright information in PMC

References

    1. Berenson RA, Paulus RA, Kalman NS. Medicare's readmissions-reduction program--a positive alternative. N Engl J Med. 2012;366:1364–1366. - PubMed
    1. Joynt KE, Jha AK. Thirty-day readmissions--truth and consequences. N Engl J Med. 2012;366:1366–1369. - PubMed
    1. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003;51:549–555. - PubMed
    1. Krumholz HM. Post-hospital syndrome--an acquired, transient condition of generalized risk. N Engl J Med. 2013;368:100–102. - PMC - PubMed
    1. Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–167. - PubMed

Publication types

LinkOut - more resources