Scaling care coordination through digital engagement: stepped-wedge trial assessing readmissions. Am J Manag Care 2024 Feb 01;30(2):e32-e38
Date
02/21/2024Pubmed ID
38381546DOI
10.37765/ajmc.2024.89498Scopus ID
2-s2.0-85185825033 (requires institutional sign-in at Scopus site)Abstract
OBJECTIVES: Transitions of care are pivotal, vulnerable times as patients are discharged from the hospital. Telephonic care coordination is standard care, but labor intensive. We implemented a patient postdischarge digital engagement (PDDE) program to scale coordination. We hypothesized that PDDE could reduce readmissions for low-risk patients and supplement care coordination for medium- and high-risk patients.
STUDY DESIGN: Pragmatic, stepped-wedge cluster randomization trial with 5 implementation waves based upon primary care clinic region.
METHODS: All inpatient hospital discharges between March 2020 and November 2020 were stratified by readmission risk. Low-risk patients were offered access to PDDE, and moderate-risk and high-risk patients were offered access to PDDE and care coordination. Readmission was defined as an unplanned inpatient admission within 30 days from discharge. An intention-to-treat primary analysis was conducted using mixed-effects logistic regression clustering for wave; a treatment-on-the-treated analysis was also conducted to assess the impact among program users.
RESULTS: A total of 5490 patient discharges were examined (2735 control; 2755 intervention); 1949 patients were high risk, 2032 were medium risk, and 1509 were low risk. PDDE intervention did not significantly affect readmission among low-risk (95% CI, -0.23 to 0.90; P = .23), medium-risk (95% CI, -0.14 to 0.60; P = .21), and high-risk (95% CI, -0.32 to 0.64; P = .48) groups after adjustment for time and patient factors. In a treatment-on-the-treated analysis, among patients who activated the PDDE program, readmission was also similar among the low-, medium-, and high-risk cohorts.
CONCLUSIONS: Our study expanded resource-limited care coordination by offering low-risk patients a service they were unable to receive previously while having no impact on readmission. PDDE efficiently provided additional touch points between patients and providers.
Author List
Polovneff A, Shah N, Janardan A, Smith E, Pasillas I, Mortensen N, Holt JM, Somai M, Sparapani R, Crotty BAuthor
Rodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AftercareHospitalization
Humans
Inpatients
Patient Discharge
Patient Readmission
