Effects of home-based intervention on unplanned readmissions and out-of-hospital deaths

Abstract

<h4>Objective</h4>To determine the effect of a home-based intervention (HBI) on the frequency of unplanned readmission and out-of-hospital death among patients discharged home from acute hospital care.<h4>Design</h4>A randomized controlled trial comparing HBI with usual care (UC).<h4>Setting</h4>A tertiary referral hospital servicing the northwestern region of Adelaide, South Australia.<h4>Participants</h4>Medical and surgical patients (n = 762) discharged home after hospitalization.<h4>Intervention</h4>Home-based intervention (n = 381) consisted of counseling of all patients before discharge followed by a single home visit (by a nurse and pharmacist) to those patients considered to be at high risk of readmission (n = 314) in order to optimize compliance with and knowledge of the treatment regimen, identify early clinical deterioration, and intensify follow-up of such patients where appropriate.<h4>Measurements</h4>The primary endpoint was the number of unplanned readmissions plus out-of-hospital deaths over a 6-month follow-up period.<h4>Results</h4>During the study follow-up, the major endpoint occurred most commonly in the UC group (217 vs 155 episodes: P < .001). Overall, the HBI group demonstrated fewer unplanned readmissions (154 vs 197: P = .022), out-of-hospital deaths (1 vs. 20: P < .001), total deaths (12 vs. 29: P = .006), emergency department attendances (236 vs 314: P < .001), and total days of hospitalization (1452 vs 1766: P < .001). There was a disproportionate reduction in multiple events among HBI patients (P = .035). Hospital-based costs of health care during study follow-up tended to be lower in the HBI group ($A2190 vs $A2680 per patient: P = .102). Mean cost of HBI was $A190 per patient visited, whereas other community-based health care costs were similar for both groups.<h4>Conclusions</h4>Among high-risk patients discharged from acute hospital care, HBI is beneficial in limiting unplanned readmissions and reducing risk of out-of-hospital death. It may be particularly cost-effective if applied selectively to patients with a history of frequent unplanned hospital admission.