by Kelsey Herbers
Following up with adult general medicine patients by phone within the week after their hospital discharge as a stand-alone intervention has no impact on readmissions, mortality or patient satisfaction, according to a new study by Vanderbilt University Medical Center researchers.
The study, published in Medical Care, randomized all patients discharged home from VUMC’s hospital general medicine program to a follow-up telephone call or usual care discharge to determine whether the telephone program reduced their chance of being readmitted within 30 days.
According to the researchers, telephone call programs are commonly used to improve a patient’s transition to outpatient care by ensuring they understand their discharge plan and have the resources they need to obtain and manage medications and schedule follow-up appointments.
The programs are designed to identify and intervene upon any factors that may make a patient unable to complete their discharge instructions, theoretically improving the likelihood of a successful transition to outpatient care.
The study enrolled more than 3,000 patients, half of which received an attempted follow-up call from a trained nurse within three to seven days following their hospital discharge. The calls were conducted by a single nurse during business hours Monday-Friday with no additional support or resources.
The researchers found no evidence of differences in 30-day inpatient readmissions, observation readmissions, emergency department revisits or mortality between patients who received a follow-up call and those who did not. There was also no evidence to support differences in patient satisfaction scores between the two patient groups.
“While a post-discharge phone call may be useful for patient care in some other ways, these results suggest that, in isolation, a telephone call alone is not enough to prevent adult hospital readmissions,” said Gordon Bernard, MD, Executive Vice President for Research at VUMC and director of the Vanderbilt Institute for Clinical and Translational Research (VICTR).
“This is a landmark study that demonstrated the best of Vanderbilt’s culture of collegiality and cooperation. A diverse group of us had a common goal of improving patient health outcomes and were able to use rigorous, reproducible research in a randomized pragmatic trial to assess an intervention. If we had not randomized this intervention, we would likely have been fooled into believing it worked,” said Dan Byrne, senior associate in VUMC’s Departments of Biostatistics and Biomedical Informatics and an author for the study.
Considering these findings, the Vanderbilt Discharge and Transition Committee was able to re-strategize VUMC’s approach to readmissions by convening a multidisciplinary team to create a multi-pronged approach focused on a safe, high quality discharge, timely post-discharge clinic follow up and collaborative management of patients discharged to the post-acute care setting.
On Aug. 24, the team also launched a comprehensive, 24/7, multidisciplinary call center to reach out to all patients discharged from Vanderbilt University Adult Hospital. The call center is staffed by nurses, pharmacists, social workers, case managers and care coordinators and provides patients with an easy-to-remember phone number for two-way communication.
The program also works with patients prior to discharge to establish a phone number at which they can be reached after their departure and lets them know to expect a follow-up call from VUMC, both of which are steps that weren’t used when conducting this study and may have contributed to the inability to reach 40% of study patients.
In the call center’s first week, it achieved a 100% contact rate. The center plans to incorporate additional technology such as text messaging to expand contact with patients and will also offer support to post-acute facilities caring for Vanderbilt patients.
“From this study, we learned that our decentralized system as first designed was insufficient to reach all of our patients. We determined that we needed to better align with evidence-based recommendations to create a centralized call center with multidisciplinary support, round-the-clock availability and a way for discharged patients and post-acute facilities to reach us if they need further assistance,” said Michele Hasselblad, vice president of Adult Ambulatory Nursing and a contributor for the study.
The researchers plan to build on these findings to determine whether more intensive and comprehensive follow-up programs offer greater success. Future studies will also explore combining comprehensive programs with a patient risk score based on the Cornelius Readmission Predictive Model to focus prevention on patients who are most likely to be readmitted.
“It could be that focusing the program on patients with the highest risk of readmission would be more successful and consume fewer human resources,” said Bernard.
This project relied on collaboration from Vanderbilt University School of Medicine’s Master of Science in Clinical Investigation (MSCI) program, VICTR’s Learning Health System, the Department of Biomedical Informatics, the Department of Biostatistics and Vanderbilt Quality, Safety and Risk Prevention.
Key contributors included Maame Yaa “Maya” Yiadom, MD, MPH, the study’s lead author, Henry Domenico, MS, the study’s lead biostatistician, and Neesha Choma, MD, MPH, executive medical director for Quality, Safety and Risk Prevention.
