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- Title
Scaling Care Coordination Through Digital Engagement: Stepped-Wedge Trial Assessing Readmissions.
- Authors
Polovneff, Alexandra; Shah, Neemit; Janardan, Abhishek; Smith, Erika; Pasillas, Ivan; Mortensen, Natalie; Holt, Jeana M.; Somai, Melek; Sparapani, Rodney; Crotty, Bradley
- Abstract
OBJECTIVES: Transitions of care are pivotal, vulnerable times as patients are discharged from the hospital. Telephonic care coordination is standard care, but labor intensive. We implemented a patient postdischarge digital engagement (PDDE) program to scale coordination. We hypothesized that PDDE could reduce readmissions for low-risk patients and supplement care coordination for medium- and high-risk patients. STUDY DESIGN: Pragmatic, stepped-wedge cluster randomization trial with 5 implementation waves based upon primary care clinic region. METHODS: All inpatient hospital discharges between March 2020 and November 2020 were stratified by readmission risk. Low-risk patients were offered access to PDDE, and moderate-risk and high-risk patients were offered access to PDDE and care coordination. Readmission was defined as an unplanned inpatient admission within 30 days from discharge. An intention-to-treat primary analysis was conducted using mixed-effects logistic regression clustering for wave; a treatment-on-the-treated analysis was also conducted to assess the impact among program users. RESULTS: A total of 5490 patient discharges were examined (2735 control; 2755 intervention); 1949 patients were high risk, 2032 were medium risk, and 1509 were low risk. PDDE intervention did not significantly affect readmission among low-risk (95% CI, -0.23 to 0.90; P = .23), medium-risk (95% CI, -0.14 to 0.60; P = .21), and high-risk (95% CI, -0.32 to 0.64; P = .48) groups after adjustment for time and patient factors. In a treatment-on-the-treated analysis, among patients who activated the PDDE program, readmission was also similar among the low-, medium-, and high-risk cohorts. CONCLUSIONS: Our study expanded resource-limited care coordination by offering low-risk patients a service they were unable to receive previously while having no impact on readmission. PDDE efficiently provided additional touch points between patients and providers.
- Subjects
PATIENT aftercare; MEDICAL quality control; EVALUATION of human services programs; HEALTH services accessibility; CONFIDENCE intervals; TRANSITIONAL care; PATIENT readmissions; MEDICAL care; DIGITAL health; CONTINUUM of care; RISK assessment; HUMAN services programs; RANDOMIZED controlled trials; PRIMARY health care; CLUSTER analysis (Statistics); STATISTICAL sampling; LOGISTIC regression analysis; PATIENT-professional relations; INTENTION; DISCHARGE planning; RESOURCE-limited settings
- Publication
American Journal of Managed Care, 2024, Vol 30, Issue 2, pe32
- ISSN
1088-0224
- Publication type
Article
- DOI
10.37765/ajmc.2024.89498