Brian W. Jack
A Reengineered Hospital Discharge Program to Decrease Rehospitalization
emergency department visits rehospitalization common hospital dischargeto test effects intervention designed minimize hospital utilization dischargerandomized trial using block randomization 6 8 randomly arranged index cards placed opaque envelopes labeled consecutively study numbers participants assigned study group revealing index cardgeneral medical service urban academic safetynet hospital749 englishspeaking hospitalized adults mean age 499 yearsa nurse discharge advocate worked patients hospital stay arrange followup appointments confirm medication reconciliation conduct patient education individualized instruction booklet sent primary care provider clinical pharmacist called patients 2 4 days discharge reinforce discharge plan review medications participants providers blinded treatment assignmentprimary outcomes emergency department visits hospitalizations within 30 days discharge secondary outcomes selfreported preparedness discharge frequency primary care providers followup within 30 days discharge research staff followup blinded study group assignmentparticipants intervention group n 370 lower rate hospital utilization receiving usual care n 368 0314 vs 0451 visit per person per month incidence rate ratio 0695 95 ci 0515 0937 p 0009 intervention effective among participants hospital utilization 6 months index admission p 0014 adverse events assessed data collected still analyzedthis singlecenter study potentially eligible patients could enrolled outcome assessment sometimes relied participant reporta package discharge services reduced hospital utilization within 30 days dischargeagency healthcare research quality national heart lung blood institute national institutes health