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Randomized Controlled Trial
. 2021 Jan;16(1):15-22.
doi: 10.12788/jhm.3513.

The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial

Jeffrey L Schnipper  1   2 , Lipika Samal  1   2 , Nyryan Nolido  1 , Catherine Yoon  1 , Anuj K Dalal  1   2 , Cherlie Magny-Normilus  1   3 , Asaf Bitton  1   2   4 , Ryan Thompson  2   5 , Stephanie Labonville  6 , Gwen Crevensten  2   5
Affiliations
Randomized Controlled Trial

The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial

Jeffrey L Schnipper et al. J Hosp Med. 2021 Jan.

Abstract

Background: Transitions from hospital to the ambulatory setting are high risk for patients in terms of adverse events, poor clinical outcomes, and readmission.

Objectives: To develop, implement, and refine a multifaceted care transitions intervention and evaluate its effects on postdischarge adverse events.

Design, setting, and participants: Two-arm, single-blind (blinded outcomes assessor), stepped-wedge, cluster-randomized clinical trial. Participants were 1,679 adult patients who belonged to one of 17 primary care practices and were admitted to a medical or surgical service at either of two participating hospitals within a pioneer accountable care organization (ACO).

Interventions: Multicomponent intervention in the 30 days following hospitalization, including inpatient pharmacist-led medication reconciliation, coordination of care between an inpatient "discharge advocate" and a primary care "responsible outpatient clinician," postdischarge phone calls, and postdischarge primary care visit.

Main outcomes and measures: The primary outcome was rate of postdischarge adverse events, as assessed by a 30-day postdischarge phone call and medical record review and adjudicated by two blinded physician reviewers. Secondary outcomes included preventable adverse events, new or worsening symptoms after discharge, and 30-day nonelective hospital readmission.

Results: Among patients included in the study, 692 were assigned to usual care and 987 to the intervention. Patients in the intervention arm had a 45% relative reduction in postdischarge adverse events (18 vs 23 events per 100 patients; adjusted incidence rate ratio, 0.55; 95% CI, 0.35-0.84). Significant reductions were also seen in preventable adverse events and in new or worsening symptoms, but there was no difference in readmission rates.

Conclusion: A multifaceted intervention was associated with a significant reduction in postdischarge adverse events but no difference in 30-day readmission rates.

Keywords: Care transition; Care coordination; Readmission; Discharge planning; Discharge process; Interdisciplinary communication; Medication reconciliation; Medication education.

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Figures

FIG 1
FIG 1
CONSORT Flow Diagram Illustrating Flow of Patient Subjects Through the Trial
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References

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