Can municipality-based post-discharge follow-up visits including a general practitioner reduce early readmission among the fragile elderly (65+ years old)? A randomized controlled trial

Abstract

Objective: To evaluate how municipality-based post-discharge follow-up visits including a general practitioner and municipal nurse affect early readmission among high-risk older people discharged from a hospital department of internal medicine.

Design and setting: Centrally randomized single-centre pragmatic controlled trial comparing intervention and usual care with investigator-blinded outcome assessment.

Intervention: The intervention was home visits with a general practitioner and municipal nurse within seven days of discharge focusing on medication, rehabilitation plan, functional level, and need for further health care initiatives. The visit was concluded by planning one or two further visits. Controls received standard health care services.

Patients: People aged 65 + years discharged from Holbæk University Hospital, Denmark, in 2012 considered at high risk of readmission.

Main outcome measures: The primary outcome was readmission within 30 days. Secondary outcomes at 30 and 180 days included readmission, primary health care, and municipal services. Outcomes were register-based and analysis used the intention-to-treat principle.

Results: A total of 270 and 261 patients were randomized to intervention and control groups, respectively. The groups were similar in baseline characteristics. In all 149 planned discharge follow-up visits were carried out (55%). Within 30 days, 24% of the intervention group and 23% of the control group were readmitted (p = 0.93). No significant differences were found for any other secondary outcomes except that the intervention group received more municipal nursing services.

Conclusion: This municipality-based follow-up intervention was only feasible in half the planned visits. The intervention as delivered had no effect on readmission or subsequent use of primary or secondary health care services.

Trial registration: ClinicalTrials.gov NCT02094040.

Keywords: Community health nursing; Denmark; frail elderly; patient readmission; population register; primary health care; quality of health care; randomized controlled trial.

Figures

Figure 1.

Flow diagram. Note: *Inclusion criteria were patients aged 65 years or older discharged alive from the Department of Internal Medicine of Holbæk University Hospital, Denmark and living in one of the three surrounding municipalities and who had dementia or two of the following conditions: two or more hospital admissions within the 12 months before the index admission, loss of physical functioning, treatment of two or more concurrent medical or surgical conditions, mental disorder, six or more prescription medications, symptoms of cognitive disturbance, substance abuse problem, disadvantaged social network, or need for increasing home care following the index admission.

Figure 2.

Time to (A) first readmission, (B) first unplanned readmission, and (C) first readmission to a department of medicine.