Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE (Open Access)

Effect of post-hospital discharge telephonic intervention on hospital readmissions in a privately insured population in Australia

G. Brent Hamar A E , Carter Coberley B , James E. Pope A , Andrew Cottrill C , Scott Verrall C , Shaun Larkin C and Elizabeth Y. Rula D
+ Author Affiliations
- Author Affiliations

A Healthways Inc., 701 Cool Springs Boulevard, Franklin, TN 37067, USA.

B 4080 Oxford Glen Drive, Franklin, TN 37067, USA. Email: carter@coberley.com

C Hospitals Contribution Fund of Australia (HCF), Level 6, 403 George Street, Sydney, NSW 2000, Australia. Email: acottrill@hcf.com.au; sverrall@hcf.com.au; slarkin@hcf.com.au

D Tivity Health, 701 Cool Springs Boulevard, Franklin, TN 37067, USA. Email: elizabeth.rula@tivityhealth.com

E Corresponding author. Email: brent.hamar@healthways.com

Australian Health Review - https://doi.org/10.1071/AH16059
Submitted: 3 March 2016  Accepted: 2 February 2017   Published online: 10 April 2017

Abstract

Objective The aim of the present study was to evaluate the effect of telephone support after hospital discharge to reduce early hospital readmission among members of the disease management program My Health Guardian (MHG) offered by the Hospitals Contribution Fund of Australia (HCF).

Methods A quasi-experimental retrospective design compared 28-day readmissions of patients with chronic disease between two groups: (1) a treatment group, consisting of MHG program members who participated in a hospital discharge (HODI) call; and (2) a comparison group of non-participating MHG members. Study groups were matched for age, gender, length of stay, index admission diagnoses and prior MHG program exposure. Adjusted incidence rate ratios (IRR) and odds ratios (OR) were estimated using zero-inflated negative binomial and logistic regression models respectively.

Results The treatment group exhibited a 29% lower incidence of 28-day readmissions than the comparison group (adjusted IRR 0.71; 95% confidence interval (CI) 0.59–0.86). The odds of treatment group members being readmitted at least once within 28 days of discharge were 25% lower than the odds for comparison members (adjusted OR 0.75; 95% CI 0.63–0.89). Reduction in readmission incidence was estimated to avoid A$713 730 in cost.

Conclusions The HODI program post-discharge telephonic support to patients recently discharged from a hospital effectively reduced the incidence and odds of hospital 28-day readmission in a diseased population.

What is known about the topic? High readmission rates are a recognised problem in Australia and contribute to the over 600 000 potentially preventable hospitalisations per year.

What does this paper add? The present study is the first study of a scalable intervention delivered to an Australian population with a wide variety of conditions for the purpose of reducing readmissions. The intervention reduced 28-day readmission incidence by 29%.

What are the implications for practitioners? The significant and sizable effect of the intervention support the delivery of telephonic support after hospital discharge as a scalable approach to reduce readmissions.


References

[1]  Vashi AA, Fox JP, Carr BG, D’Onofrio G, Pines JM, Ross JS, Gross CP. Use of hospital-based acute care among patients recently discharged from the hospital. JAMA 2013; 309 364–71.
Use of hospital-based acute care among patients recently discharged from the hospital.CrossRef | 1:CAS:528:DC%2BC3sXhsFahtbc%3D&md5=52d0444f4f8f2ea2804de70b9f6f02c6CAS |

[2]  Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360 1418–28.
Rehospitalizations among patients in the Medicare fee-for-service program.CrossRef | 1:CAS:528:DC%2BD1MXjvFGju7c%3D&md5=132d8b98c2ae98728971a3ebd263fb24CAS |

[3]  Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, Barreto-Filho JA, Kim N, Bernheim SM, Suter LG, Drye EE, Krumholz HM. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA 2013; 309 355–63.
Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia.CrossRef | 1:CAS:528:DC%2BC3sXhsFWrsrc%3D&md5=59d3c68f74d19396f85c48f8633374eaCAS |

[4]  Swannell C. Readmission rates too high. MJA InSight 2013; 2. Available at: https://www.mja.com.au/insight/2013/2/readmission-rates-too-high [verified 31 July 2015].

[5]  Scott I, Shohag H, Ahmed M. Quality of care factors associated with unplanned readmissions of older medical patients: a case-control study. Intern Med J 2014; 44 161–70.
Quality of care factors associated with unplanned readmissions of older medical patients: a case-control study.CrossRef | 1:STN:280:DC%2BC2c3kslGnsA%3D%3D&md5=23c2269bc37a2a363b209d992334d6b1CAS |

[6]  Renton J, Pilcher D, Santamaria J, Stow P, Bailey M, Hart G, Duke G. Factors associated with increased risk of readmission to intensive care in Australia. Intensive Care Med 2011; 37 1800–8.
Factors associated with increased risk of readmission to intensive care in Australia.CrossRef | 1:STN:280:DC%2BC3MbhslKrtg%3D%3D&md5=84bcdd6b700bf77530ca109d71595c42CAS |

[7]  Atkins ER, Geelhoed EA, Knuiman M, Briffa TG. One third of hospital costs for atherothrombotic disease are attributable to readmissions: a linked data analysis. BMC Health Serv Res 2014; 14 338–46.
One third of hospital costs for atherothrombotic disease are attributable to readmissions: a linked data analysis.CrossRef |

[8]  Australasian College for Emergency Medicine. Policy on standard terminology. Document no. P02. 2014. Available at: https://www.acem.org.au/getattachment/3907984e-2a6c-4789-9f11-5d1d75f0e837/Policy-on-Standard-Terminology.aspx [verified 11 August 2015].

[9]  Australasian College for Emergency Medicine. Access block and overcrowding in emergency departments. 2004. Available at: https://www.acem.org.au/getattachment/56688d18-4f4c-467a-bba3-704d994d9f2d/Access-Block-2004-literature-review.aspx [verified 11 August 2015].

[10]  Forero R, McCarthy S, Hillman K. Access block and emergency department overcrowding. Crit Care 2011; 15(2) 1–6.
Access block and emergency department overcrowding.CrossRef |

[11]  Scott IA. Public hospital bed crisis: too few or too misused? Aust Health Rev 2010; 34 317–24.
Public hospital bed crisis: too few or too misused?CrossRef |

[12]  Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, McCarthy M, McConnell KJ, Pines JM, Rathlev N, Schafermeyer R, Zwemer F, Schull M, Asplin BR. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med 2009; 16 1–10.
The effect of emergency department crowding on clinically oriented outcomes.CrossRef |

[13]  Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust 2006; 184 213–6.

[14]  Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP, DELAY-ED Study Group Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 2007; 35 1477–83.
Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit.CrossRef |

[15]  Sprivulis PC, Da Silva J, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust 2006; 184 208–12.

[16]  Australian Institute of Health and Welfare. National Healthcare Agreement: PI 18 – selected potentially preventable hospitalisations, 2015. 2016. Available at: http://meteor.aihw.gov.au/content/index.phtml/itemId/559032 [verified 2 March 2016].

[17]  Australian Health Ministers’ Advisory Council (AHMAC). Aboriginal and Torres Strait Islander health performance framework 2014 report. Canberra: AHMAC; 2015. Available at: https://www.dpmc.gov.au/sites/default/files/publications/Aboriginal_and_Torres_Strait_Islander_HPF_2014%20-%20edited%2016%20June2015.pdf [verified 11 February 2017].

[18]  Australian Institute of Health and Welfare. National healthcare agreement 2015. 2017. Available at: http://meteor.aihw.gov.au/content/index.phtml/itemId/629963 [verified 11 February 2017].

[19]  van Walraven C, Jennings A, Forster AJ. A meta-analysis of hospital 30-day avoidable readmission rates. J Eval Clin Pract 2012; 18 1211–8.
A meta-analysis of hospital 30-day avoidable readmission rates.CrossRef |

[20]  Greenwald JL, Denham CR, Jack BW. The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process. J Patient Saf 2007; 3 97–106.
The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process.CrossRef |

[21]  Marcantonio ER, McKean S, Goldfinger M, Kleefield S, Yurkofsky M, Brennan TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. Am J Med 1999; 107 13–7.
Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan.CrossRef | 1:STN:280:DyaK1MzjtVWnsw%3D%3D&md5=73ad778bc4e6743794900179e3896a49CAS |

[22]  Snyderman D, Salzman B, Mills G, Hersh L, Parks S. Strategies to help reduce hospital readmissions. J Fam Pract 2014; 63 430–8.

[23]  Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med 2007; 2 314–23.
Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists.CrossRef |

[24]  Weiss ME, Piacentine LB, Lokken L, Ancona J, Archer J, Gresser S, Holmes SB, Toman S, Toy A, Vega-Stromberg T. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec 2007; 21 31–42.
Perceived readiness for hospital discharge in adult medical-surgical patients.CrossRef |

[25]  van Walraven C, Seth R, Austin PC, Laupacis A. Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med 2002; 17 186–92.
Effect of discharge summary availability during post-discharge visits on hospital readmission.CrossRef |

[26]  Roy CL, Poon EG, Karson AS, Ladak-Merchant Z, Johnson RE, Maviglia SM, Gandhi TK. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med 2005; 143 121–8.
Patient safety concerns arising from test results that return after hospital discharge.CrossRef |

[27]  Mudge AM, Shakhovskoy R, Karrasch A. Quality of transitions in older medical patients with frequent readmissions: opportunities for improvement. Eur J Intern Med 2013; 24 779–83.
Quality of transitions in older medical patients with frequent readmissions: opportunities for improvement.CrossRef |

[28]  Tricco AC, Antony J, Ivers NM, Ashoor HM, Khan PA, Blondal E, Ghassemi M, MacDonald H, Chen MH, Ezer LK, Straus SE. Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis. CMAJ 2014; 186 E568–78.
Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis.CrossRef |

[29]  Hamar GB, Rula EY, Wells A, Coberley C, Pope JE, Larkin S. Impact of a chronic disease management program on hospital admissions and readmissions in an Australian population with heart disease or diabetes. Popul Health Manag 2013; 16 125–31.
Impact of a chronic disease management program on hospital admissions and readmissions in an Australian population with heart disease or diabetes.CrossRef |

[30]  Hamar GB, Rula EY, Coberley C, Pope JE, Larkin S. Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes. BMC Health Serv Res 2015; 15 174–82.
Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes.CrossRef |

[31]  King G, Nielsen R, Coberley C, Pope E, Wells A. Comparative effectiveness of matching methods for causal inference. Unpublished white paper. 2011. Available at: http://gking.harvard.edu/files/psparadox.pdf [verified 2 February 2017].

[32]  Wells AR, Hamar B, Bradley C, Gandy WM, Harrison PL, Sidney JA, Coberley CR, Rula EY, Pope JE. Exploring robust methods for evaluating treatment and comparison groups in chronic care management programs. Popul Health Manag 2013; 16 35–45.
Exploring robust methods for evaluating treatment and comparison groups in chronic care management programs.CrossRef |

[33]  Blackwell M, Iacus S, King G, Porro G. CEM: coarsened exact matching in Stata. Stata J 2009; 9 524–46.

[34]  King G, Iacus SM. How coarsening simplifies matching-based causal inference theory. Cambridge, MA: Harvard University; 2012. Available online at: https://www.semanticscholar.org/paper/How-Coarsening-Simplifies-Matching-Based-Causal-Iacus-King/6838125d944b31a1f958f86c08940b37a2e6047c [verified 23 February 2017].

[35]  Iacus SM, King G, Porro G. CEM: software for coarsened exact matching. J Stat Softw 2009; 30 1–27.
CEM: software for coarsened exact matching.CrossRef |

[36]  Scott IA. Preventing the rebound: improving care transition in hospital discharge processes. Aust Health Rev 2010; 34 445–51.
Preventing the rebound: improving care transition in hospital discharge processes.CrossRef |

[37]  Harrison PL, Hara PA, Pope JE, Young MC, Rula EY. The impact of postdischarge telephonic follow-up on hospital readmissions. Popul Health Manag 2011; 14 27–32.
The impact of postdischarge telephonic follow-up on hospital readmissions.CrossRef |

[38]  Australian Institute of Health and Welfare (AIHW). Admitted patient care 2013–2014: Australian hospital statistics. Health Services Series no. 60, Catalogue no. HSE 156. Canberra: AIHW; 2015.

[39]  Velengtas P, Mohr P, Messner DA. Making informed decisions: assessing the strengths and weaknesses of study designs and analytic methods for comparative effectiveness research, a briefing document for stakeholders. Washington, DC: National Pharmaceutical Council; 2012.


Full Text PDF (159 KB) Export Citation

View Altmetrics