Management of Nursing Home Residents Following Acute Hospitalization: Efficacy of the "Regular Early Assessment Post-Discharge (REAP)" Intervention

Nicholas J Cordato¹, Mary Kearns², Peter Smerdely³, Katrin M Seeher⁴, Matthew D Gardiner⁵, Henry Brodaty⁶

Affiliations

¹ Department of Aged Care, St George Hospital, Kogarah, Australia; Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia. Electronic address: nicholas.cordato@health.nsw.gov.au.
² Department of Aged Care, St George Hospital, Kogarah, Australia.
³ Department of Aged Care, St George Hospital, Kogarah, Australia; Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
⁴ Faculty of Medicine, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.
⁵ Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
⁶ Faculty of Medicine, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia. Electronic address: h.brodaty@unsw.edu.au.

PMID: 29396192
DOI: 10.1016/j.jamda.2017.12.008

Randomized Controlled Trial

Management of Nursing Home Residents Following Acute Hospitalization: Efficacy of the "Regular Early Assessment Post-Discharge (REAP)" Intervention

Nicholas J Cordato et al. J Am Med Dir Assoc. 2018 Mar.

. 2018 Mar;19(3):276.e11-276.e19.

doi: 10.1016/j.jamda.2017.12.008. Epub 2018 Feb 1.

Authors

Nicholas J Cordato¹, Mary Kearns², Peter Smerdely³, Katrin M Seeher⁴, Matthew D Gardiner⁵, Henry Brodaty⁶

Affiliations

¹ Department of Aged Care, St George Hospital, Kogarah, Australia; Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia. Electronic address: nicholas.cordato@health.nsw.gov.au.
² Department of Aged Care, St George Hospital, Kogarah, Australia.
³ Department of Aged Care, St George Hospital, Kogarah, Australia; Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
⁴ Faculty of Medicine, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.
⁵ Calvary Health Care Sydney, Kogarah, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
⁶ Faculty of Medicine, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia. Electronic address: h.brodaty@unsw.edu.au.

PMID: 29396192
DOI: 10.1016/j.jamda.2017.12.008

Abstract

Objectives: Rehospitalization of nursing home (NH) residents is frequent, costly, potentially avoidable and associated with diminished quality of life and poor survival. This study aims to evaluate the impact and cost-effectiveness of the Regular Early Assessment Post-Discharge (REAP) protocol of coordinated specialist geriatrician and nurse practitioner visits on rates of rehospitalization, hospital length of stay, and emergency department presentations for NH residents recently discharged from hospital.

Design: Prospective randomized controlled study of recently hospitalized NH residents.

Setting: Twenty-one of 24 eligible NHs within the geographical catchment area of St George Hospital, a 650-bed university hospital in Sydney, Australia.

Participants: NH residents from eligible facilities admitted to St George Hospital's geriatric service were enrolled prior to hospital discharge.

Intervention: REAP intervention of monthly coordinated specialist geriatrician and nurse practitioner assessments within participants' NHs for 6 months following hospital discharge.

Measurements: Impact of the REAP intervention on hospital readmissions, hospital inpatient days, emergency department utilization, general practitioner visits, investigations and associated costs during the study intervention period.

Results: Forty-three NH residents were randomly allocated to REAP intervention (n = 22) or control (n = 21) groups. The REAP intervention group had almost two-thirds fewer hospital readmissions (P = .03; Cohen's d = 0.73) and half as many emergency department visits than controls. Total costs were 50% lower in the REAP intervention group, with lower total hospital inpatient (P = .04; Cohen's d = 0.63) and total emergency department (P = .04; Cohen's d = 0.65) costs.

Conclusion: Cost-effective reductions in the utilization of hospital-related services were demonstrated following implementation of the REAP intervention for NH residents recently discharged from hospital.

Keywords: Geriatrics; costs; follow-up; nursing home; rehospitalization.

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Management of Nursing Home Residents Following Acute Hospitalization: Efficacy of the "Regular Early Assessment Post-Discharge (REAP)" Intervention

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Management of Nursing Home Residents Following Acute Hospitalization: Efficacy of the "Regular Early Assessment Post-Discharge (REAP)" Intervention

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