Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge—Trust Matters, Too

作者：Jing Li, Jessica Miller Clouser, Jane Brock, Terry C. Davis, Brian W. Jack, Carol Levine, Glen P. Mays, Brian S. Mittman, Huong Q. Nguyen, Joann Sorra, Arnold J. Stromberg, Gaixin Du, Chen Dai, Akosua Adu, Nikita Vundi, Mark V. Williams · 发表于：The Joint Commission Journal on Quality and Patient Safety · 年份：2021 · DOI：10.1016/j.jcjq.2021.09.012 · 被引用次数：27 · 研究领域：Heart Failure Treatment and Management、Sepsis Diagnosis and Treatment、Hospital Admissions and Outcomes

BACKGROUND: As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain. METHODS: Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes. Using purposive sampling, the research team recruited a diverse sample of short-term acute care and critical access hospitals in the United States (N = 42) and analyzed data on eligible Medicare beneficiaries (N = 7,939) discharged from their medical/surgical units. Using both hospital- and patient-reported TC strategy exposure data, the project compared patients "exposed" to each of five overlapping groups of TC strategies to their "control" counterparts. Primary outcomes included 30-day hospital readmissions, 7-day postdischarge emergency department (ED) visits and patient-reported physical and mental health, pain, and participation in daily activities. RESULTS: Participants averaged 72.3 years old (standard deviation =10.1), 53.4% were female, and most were White (78.9%). Patients exposed to one TC group (Hospital-Based Trust, Plain Language, and Coordination) were less likely to have 30-day readmissions (risk ratio [RR], 0.72; 95% confidence int...