Transitional Care Interventions Reduce Emergency Hospital Readmissions in Older Adults

Monday, 22 July 2013: 1:30 PM

Mary Courtney, PhD, MHP, BAdmin (Acc), RN
School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
Anne M. Chang, PhD, MEdSt, BEdSt, DipNEd, RN
Nursing Research Centre (inc. Queensland Centre for Evidence Based Nursing and Midwifery), Mater Health Services, Brisbane, Australia
Helen Ethel Edwards, OAM, PhD, BA (Hons), BA, DipApSc, RN
School of Nursing, Queensland University of Technology, Brisbane, Australia
Anthony Parker, PhD, MS, BS
School of Human Movements, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
Kathleen Finlayson, PhD, MN, BN
School of Nursing & Midwifery, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia

Learning Objective 1: The learner wil be able to identify factors influencing emergency hospital readmissions in older adults

Learning Objective 2: The learner will be able to identify some transitional care strategies for reducing emergency hospital readmissions

Older adults account for the majority of hospital admissions, often experience multiple co-morbid conditions and have higher rates of emergency hospital readmissions than the general population. The purpose of this study was to conduct a randomised controlled trial to evaluate the relative effectiveness of transitional care interventions for community-based older adults on emergency hospital readmissions in the 28 days following discharge.

A sample of 222 patients aged 65 years or older, with at least one known risk factor for hospital readmission, was recruited from medical wards in two metropolitan hospitals in Australia. Participants were randomised to either: usual care; an exercise intervention; a nurse in-home and telephone follow-up intervention; or a combined exercise and nursing follow-up intervention. Data were collected from participant surveys and hospital records.

The average age of participants was 78 years (SD 6.64). They were most frequently admitted with respiratory disease (38%) or cardiac disease (23%), and had a median of four co-morbidities.  In the first 28 days following discharge, 15.3% (n=31) of participants had an emergency readmission, 25% in the control group, and 14%, 12% and 9% in the exercise intervention, nurse intervention and combined intervention groups respectively. A Cox proportional hazards regression model found that the group receiving the combined interventions were 3.4 times (95% CI 1.15–10.1) less likely to experience an emergency readmission in comparison to the control group (p=0.03). Other significant predictors of emergency readmissions were increasing age, renal disease, depression and lower levels of chronic disease self efficacy.

A multifaceted transitional care intervention for older adults at known risk of readmissions can halve the number of emergency readmissions. Implementation of this strategy is likely to improve health and decrease costs to the health care system.