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Journal of General Internal Medicine

, Volume 34, Issue 1, pp 58–64 | Cite as

Aiming to Improve Readmissions Through InteGrated Hospital Transitions (AIRTIGHT): a Pragmatic Randomized Controlled Trial

  • Andrew McWilliamsEmail author
  • Jason Roberge
  • William E. Anderson
  • Charity G. Moore
  • Whitney Rossman
  • Stephanie Murphy
  • Stephannie McCall
  • Ryan Brown
  • Shannon Carpenter
  • Scott Rissmiller
  • Scott Furney
Original Research

Abstract

Background

Despite years of intense focus, inpatient and observation readmission rates remain high and largely unchanged. Hospitals have little, robust evidence to guide the selection of interventions effective at reducing 30-day readmissions in real-world settings.

Objective

To evaluate if implementation of recent recommendations for hospital transition programs is effective at reducing 30-day readmissions in a population discharged to home and at high-risk for readmission.

Design

A non-blinded, pragmatic randomized controlled trial (Clinicaltrials.gov: NCT02763202) conducted at two hospitals in Charlotte, North Carolina.

Patients

A total of 1876 adult patients, under the care of a hospitalist, and at high risk for readmissions.

Intervention

Random allocation to a Transition Services (TS) program (n = 935) that bridges inpatient, outpatient, and home settings, providing patients virtual and in-person access to a dedicated multidisciplinary team for 30-days, or usual care (n = 941).

Main Measure

Thirty-day, unplanned, inpatient, or observation readmission rate.

Key Results

The 30-day readmission rate was 15.2% in the TS group and 16.3% in the usual care group (RR 0.93; 95% [CI, 0.76 to 1.15]; P = 0.52). There were no significant differences in readmissions at 60 and 90 days or in 30-day Emergency Department visit rates. Patients, who were referred to TS and readmitted, had less Intensive Care Unit admissions 15.5% vs. 26.8% (RR 0.74; 95% [CI, 0.59 to 0.93]; P = 0.02).

Conclusions

An intervention inclusive of contemporary recommendations does not reduce a high-risk population’s 30-day readmission rate. The high crossover to usual care (74.8%) reflects the challenge of non-participation that is ubiquitous in the real-world implementation of population health interventions.

Trial Registry

ClinicalTrials.gov; registration ID number: NCT02763202, URL: https://clinicaltrials.gov/ct2/show/NCT02763202

KEY WORDS

readmissions population health outcomes research healthcare value pragmatic research 

Notes

Primary Funding Source

Carolinas HealthCare System

Compliance with Ethical Standards

The trial was approved by the Carolinas HealthCare System Institutional Review Board and granted a waiver for patient consent (reference number 01-15-10E).

Conflict of Interest

AM has received funding support for research from AstraZeneca, Amylin Pharmaceuticals, and is a cofounder of iEnroll, LLC. No other authors report any potential conflicts of interest.

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Andrew McWilliams
    • 1
    Email author
  • Jason Roberge
    • 1
  • William E. Anderson
    • 1
  • Charity G. Moore
    • 2
  • Whitney Rossman
    • 1
  • Stephanie Murphy
    • 1
  • Stephannie McCall
    • 1
  • Ryan Brown
    • 1
  • Shannon Carpenter
    • 1
  • Scott Rissmiller
    • 1
  • Scott Furney
    • 1
  1. 1.Carolinas Health Care SystemCharlotteUSA
  2. 2.University of PittsburghPittsburghUSA

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