Multidisciplinary intervention reducing readmissions in medical inpatients: a prospective, non-randomized study

Abstract

Background

The purpose of this study was to examine whether a multidisciplinary intervention targeting drug-related problems, cognitive impairment, and discharge miscommunication could reduce readmissions in a general hospital population.

Methods

This prospective, non-randomized intervention study was carried out at the department of general internal medicine at a tertiary university hospital. Two hundred medical inpatients living in the community and aged over 60 years were included. Ninety-nine patients received interventions and 101 received standard care. Control/intervention allocation was determined by geographic selection. Interventions consisted of a comprehensive medication review, improved discharge planning, post-discharge telephone follow-up, and liaison with the patient’s general practitioner. The main outcome measures recorded were readmissions and hospital nights 12 months after discharge. Separate analyses were made for 12-month survivors and from an intention-to-treat perspective. Comparative analyses were made between groups as well as within groups over time.

Results

After 12 months, survivors in the control group had 125 readmissions in total, compared with 58 in the intervention group (Mann–Whitney U test, P = 0.02). For hospital nights, the numbers were 1,228 and 492, respectively (P = 0.009). Yearly admissions had increased from the previous year in the control group from 77 to 125 (Wilcoxon signed-rank test, P = 0.002) and decreased from 75 to 58 in the intervention group (P = 0.25). From the intention-to-treat perspective, the same general pattern was observed but was not significant (1,827 versus 1,008 hospital nights, Mann–Whitney test, P = 0.054).

Conclusion

A multidisciplinary approach, targeting several different areas, could substantially lower readmissions and hospital costs in a non-terminal general hospital population.

Keywords:

• medical inpatients
• hospital readmissions
• intervention
• drug-related problems
• cognitive impairment
• hospital discharge

Supplementary materials

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Acknowledgments

This study was funded by the Swedish Research Council (Vetenskapsrådet #523-2010-520), the Swedish Brain Power program, the National Swedish Board of Health and Welfare, and the Governmental Funding of Clinical Research within the National Health Services. The sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. We would like to thank Anna Johansson, Sofa Raccuia, Cecilia Lenander, Annika Dobszai, and Jenny Cappelin for help with acquisition of data.

Disclosure

LS is a member of an expert group writing a report on “acute care of elderly in hospitals” on behalf of the Swedish Council of Health Technology Assessment (a governmental agency). The other authors declare no conflicts of interest in this work.