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Medientyp:
E-Artikel
Titel:
Telephone Follow‐Up for Older Adults Discharged to Home from the Emergency Department: A Pragmatic Randomized Controlled Trial
Beteiligte:
Biese, Kevin J.;
Busby‐Whitehead, Jan;
Cai, Jianwen;
Stearns, Sally C.;
Roberts, Ellen;
Mihas, Paul;
Emmett, Doug;
Zhou, Qingning;
Farmer, Franklin;
Kizer, John S.
Erschienen:
Wiley, 2018
Erschienen in:Journal of the American Geriatrics Society
Sprache:
Englisch
DOI:
10.1111/jgs.15142
ISSN:
0002-8614;
1532-5415
Entstehung:
Anmerkungen:
Beschreibung:
<jats:sec><jats:title>Background/Objectives</jats:title><jats:p>Telephone calls after discharge from the emergency department (<jats:styled-content style="fixed-case">ED</jats:styled-content>) are increasingly used to reduce 30‐day rates of return or readmission, but their effectiveness is not established. The objective was to determine whether a scripted telephone intervention by registered nurses from a hospital‐based call center would decrease 30‐day rates of return to the <jats:styled-content style="fixed-case">ED</jats:styled-content> or hospital or of death.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Randomized, controlled trial from 2013 to 2016.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Large, academic medical center in the southeast United States.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Individuals aged 65 and older discharged from the <jats:styled-content style="fixed-case">ED</jats:styled-content> were enrolled and randomized into intervention and control groups (N = 2,000).</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p>Intervention included a telephone call from a nurse using a scripted questionnaire to identify obstacles to elements of successful care transitions: medication acquisition, postdischarge instructions, and obtaining physician follow‐up. Control subjects received a satisfaction survey only.</jats:p></jats:sec><jats:sec><jats:title>Measurements</jats:title><jats:p>Primary outcome was return to the <jats:styled-content style="fixed-case">ED</jats:styled-content>, hospitalization, or death within 30 days of discharge from the <jats:styled-content style="fixed-case">ED</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Rate of return to the <jats:styled-content style="fixed-case">ED</jats:styled-content> or hospital or death within 30 days was 15.5% (95% confidence interval (<jats:styled-content style="fixed-case">CI</jats:styled-content>) = 13.2–17.8%) in the intervention group and 15.2% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 12.9–17.5%) in the control group (<jats:italic>P</jats:italic> = .86). Death was uncommon (intervention group, 0; control group, 5 (0.51%), 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 0.06–0.96%); 12.2% of intervention subjects (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 10.1–14.3%) and 12.5% of control subjects (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 10.4–14.6%) returned to the <jats:styled-content style="fixed-case">ED</jats:styled-content>, and 9% of intervention subjects (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 7.2–10.8%) and 7.4% of control subjects (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 5.8–9.0%) were hospitalized within 30 days.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>A scripted telephone call from a trained nurse to an older adult after discharge from the <jats:styled-content style="fixed-case">ED</jats:styled-content> did not reduce <jats:styled-content style="fixed-case">ED</jats:styled-content> or hospital return rates or death within 30 days. Clinicaltrials.gov identifier: NCT01893931z.</jats:p></jats:sec>