Care transitions intervention reduces ED revisits in cognitively impaired patients
Abstract Introduction About half of older adults with impaired cognition who are discharged home from the emergency department (ED) return for further care within 30 days. We tested the effect of an adapted Care Transitions Intervention (CTI) at reducing ED revisits in this vulnerable population. Me...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
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| Series: | Alzheimer’s & Dementia: Translational Research & Clinical Interventions |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/trc2.12261 |
| _version_ | 1797948996838227968 |
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| author | Manish N. Shah Gwen C. Jacobsohn Courtney MC Jones Rebecca K. Green Thomas V. Caprio Amy L. Cochran Jeremy T. Cushman Michael Lohmeier Amy J.H. Kind |
| author_facet | Manish N. Shah Gwen C. Jacobsohn Courtney MC Jones Rebecca K. Green Thomas V. Caprio Amy L. Cochran Jeremy T. Cushman Michael Lohmeier Amy J.H. Kind |
| author_sort | Manish N. Shah |
| collection | DOAJ |
| description | Abstract Introduction About half of older adults with impaired cognition who are discharged home from the emergency department (ED) return for further care within 30 days. We tested the effect of an adapted Care Transitions Intervention (CTI) at reducing ED revisits in this vulnerable population. Methods We conducted a pre‐planned subgroup analysis of community‐dwelling, cognitively impaired older (age ≥60 years) participants from a randomized controlled trial testing the effectiveness of the CTI adapted for ED‐to‐home transitions. The parent study recruited ED patients from three university‐affiliated hospitals from 2016 to 2019. Subjects eligible for this sub‐analysis had to: (1) have a primary care provider within these health systems; (2) be discharged to a community residence; (3) not receive care management or hospice services; and (4) be cognitively impaired in the ED, as determined by a score >10 on the Blessed Orientation Memory Concentration Test. The primary outcome, ED revisits within 30 days of discharge, was abstracted from medical records and evaluated using logistic regression. Results Of our sub‐sample (N = 81, 36 control, 45 treatment), 57% were female and the mean age was 78 years. Multivariate analysis, adjusted for the presence of moderate to severe depression and inadequate health literacy, found that the CTI significantly reduced the odds of a repeat ED visit within 30 days (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.07 to 0.90) but not 14 days (OR 1.01, 95% CI 0.26 to 3.93). Multivariate analysis of outpatient follow‐up found no significant effects. Discussion Community‐dwelling older adults with cognitive impairment receiving the CTI following ED discharge experienced fewer ED revisits within 30 days compared to usual care. Further studies must confirm and expand upon this finding, identifying features with greatest benefit to patients and caregivers. |
| first_indexed | 2024-04-10T21:53:30Z |
| format | Article |
| id | doaj.art-889b69db83b847009f09e197fff25b16 |
| institution | Directory Open Access Journal |
| issn | 2352-8737 |
| language | English |
| last_indexed | 2024-04-10T21:53:30Z |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Alzheimer’s & Dementia: Translational Research & Clinical Interventions |
| spelling | doaj.art-889b69db83b847009f09e197fff25b162023-01-18T11:41:03ZengWileyAlzheimer’s & Dementia: Translational Research & Clinical Interventions2352-87372022-01-0181n/an/a10.1002/trc2.12261Care transitions intervention reduces ED revisits in cognitively impaired patientsManish N. Shah0Gwen C. Jacobsohn1Courtney MC Jones2Rebecca K. Green3Thomas V. Caprio4Amy L. Cochran5Jeremy T. Cushman6Michael Lohmeier7Amy J.H. Kind8BerbeeWalsh Department of Emergency Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USABerbeeWalsh Department of Emergency Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USADepartment of Emergency Medicine University of Rochester Medical Center Rochester New York USABerbeeWalsh Department of Emergency Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USADepartment of Medicine, Division of Geriatrics University of Rochester Medical Center Rochester New York USADepartment of Population Health Sciences University of Wisconsin School of Medicine and Public Health Madison Wisconsin USADepartment of Emergency Medicine University of Rochester Medical Center Rochester New York USABerbeeWalsh Department of Emergency Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USADepartment of Medicine (Geriatrics and Gerontology) University of Wisconsin School of Medicine and Public Health Madison Wisconsin USAAbstract Introduction About half of older adults with impaired cognition who are discharged home from the emergency department (ED) return for further care within 30 days. We tested the effect of an adapted Care Transitions Intervention (CTI) at reducing ED revisits in this vulnerable population. Methods We conducted a pre‐planned subgroup analysis of community‐dwelling, cognitively impaired older (age ≥60 years) participants from a randomized controlled trial testing the effectiveness of the CTI adapted for ED‐to‐home transitions. The parent study recruited ED patients from three university‐affiliated hospitals from 2016 to 2019. Subjects eligible for this sub‐analysis had to: (1) have a primary care provider within these health systems; (2) be discharged to a community residence; (3) not receive care management or hospice services; and (4) be cognitively impaired in the ED, as determined by a score >10 on the Blessed Orientation Memory Concentration Test. The primary outcome, ED revisits within 30 days of discharge, was abstracted from medical records and evaluated using logistic regression. Results Of our sub‐sample (N = 81, 36 control, 45 treatment), 57% were female and the mean age was 78 years. Multivariate analysis, adjusted for the presence of moderate to severe depression and inadequate health literacy, found that the CTI significantly reduced the odds of a repeat ED visit within 30 days (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.07 to 0.90) but not 14 days (OR 1.01, 95% CI 0.26 to 3.93). Multivariate analysis of outpatient follow‐up found no significant effects. Discussion Community‐dwelling older adults with cognitive impairment receiving the CTI following ED discharge experienced fewer ED revisits within 30 days compared to usual care. Further studies must confirm and expand upon this finding, identifying features with greatest benefit to patients and caregivers.https://doi.org/10.1002/trc2.12261care transitionscare transitions interventioncognitive impairmentcommunity paramedicinedementiaemergency department |
| spellingShingle | Manish N. Shah Gwen C. Jacobsohn Courtney MC Jones Rebecca K. Green Thomas V. Caprio Amy L. Cochran Jeremy T. Cushman Michael Lohmeier Amy J.H. Kind Care transitions intervention reduces ED revisits in cognitively impaired patients Alzheimer’s & Dementia: Translational Research & Clinical Interventions care transitions care transitions intervention cognitive impairment community paramedicine dementia emergency department |
| title | Care transitions intervention reduces ED revisits in cognitively impaired patients |
| title_full | Care transitions intervention reduces ED revisits in cognitively impaired patients |
| title_fullStr | Care transitions intervention reduces ED revisits in cognitively impaired patients |
| title_full_unstemmed | Care transitions intervention reduces ED revisits in cognitively impaired patients |
| title_short | Care transitions intervention reduces ED revisits in cognitively impaired patients |
| title_sort | care transitions intervention reduces ed revisits in cognitively impaired patients |
| topic | care transitions care transitions intervention cognitive impairment community paramedicine dementia emergency department |
| url | https://doi.org/10.1002/trc2.12261 |
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