Multimodal transitional care intervention fails to prevent hospital readmission or death in high-risk patients: JAMA

Switzerland: The findings, published in JAMA Internal Medicine, show the difficulties in preventing hospital readmissions, even when standardized multimodal care transition interventions specifically target higher-risk patients.

Many complications can occur when patients are discharged from hospitals to ambulatory settings, leading to costly hospital readmissions and unnecessary patient distress. 30% of readmissions are preventable, and about 50% are potentially avoidable. For these reasons, readmission has received increased attention from policy maker. Although incentives have been introduced to reduce them, there is no clarity on the best interventions for reducing readmissions.

Against the above background, Jacques Donzé and colleagues from Switzerland aimed to assess the effects of a multimodal transitional care intervention targeting high-risk patients on the composite outcome of 30-day unplanned hospital readmission or mortality. They also explored the impact of the intervention on post-discharge health care use, time to readmission or death, patients' perspectives on the quality of their care transition, and costs.

For this purpose, the researchers conducted a multicenter, single-blinded, randomized clinical trial with a 30-day follow-up in 4 medium-to-large–sized teaching hospitals in Switzerland. Participants included consecutive patients discharged from general wards and at higher risk of unplanned readmission on the basis of their simplified HOSPITAL score (≥4 points).

The intervention group underwent a 15-minute patient education session with teach-back, systematic medication reconciliation, post-discharge telephone calls from the study team, and a planned first follow-up visit with their physician. The control group was given usual care from their hospitalist and a 1-page standard study information sheet.

The authors reported the following findings:

• The study included 1386 patients (mean age of 72; 51% were male).
• In the intervention group, the composite outcome of 30-day unplanned readmission or death was 21% and 19% in the control group.
• The intention-to-treat analysis risk difference was 1.7%.
• The authors found no evidence of any intervention effects on time to unplanned readmission or death, patient satisfaction with the quality of their care transition, post-discharge healthcare use, or readmission costs.

"Our study findings suggest that difficulties in preventing hospital readmissions continue, even when using multimodal interventions targeting higher-risk patients," the researchers concluded. They noted that this particular intervention added to uncertainties about the real benefits and impacts of trying to monitor and reduce this indicator of care.

Reference:

Donzé J, John G, Genné D, et al. Effects of a Multimodal Transitional Care Intervention in Patients at High Risk of Readmission: The TARGET-READ Randomized Clinical Trial. JAMA Intern Med. Published online May 01, 2023. doi:10.1001/jamainternmed.2023.0791