Discharge Information and Support for Patients Discharged from the Emergency Department: Results from a Randomized Controlled Trial
Little research has been done on primary care–based models to improve health care use after an emergency department (ED) visit.
To examine the effectiveness of a primary care–based, nurse telephone support intervention for Veterans treated and released from the ED.
Randomized controlled trial with 1:1 assignment to telephone support intervention or usual care arms (ClinicalTrials.gov: NCT01717976).
Department of Veterans Affairs Health Care System (VAHCS) in Durham, NC.
Five hundred thirteen Veterans who were at high risk for repeat ED visits.
The telephone support intervention consisted of two core calls in the week following an ED visit. Call content focused on improving the ED to primary care transition, enhancing chronic disease management, and educating Veterans and family members about VHA and community services.
The primary outcome was repeat ED use within 30 days.
Observed rates of repeat ED use at 30 days in usual care and intervention groups were 23.1% and 24.9%, respectively (OR = 1.1; 95% CI = 0.7, 1.7; P = 0.6). The intervention group had a higher rate of having at least 1 primary care visit at 30 days (OR = 1.6, 95% CI = 1.1–2.3). At 180 days, the intervention group had a higher rate of usage of a weight management program (OR = 3.5, 95% CI = 1.6–7.5), diabetes/nutrition (OR = 1.8, 95% CI = 1.0–3.0), and home telehealth services (OR = 1.7, 95% CI = 1.0–2.9) compared with usual care.
A brief primary care–based nurse telephone support program after an ED visit did not reduce repeat ED visits within 30 days, despite intervention participants’ increased engagement with primary care and some chronic disease management services.
KEY WORDSrandomized trials Veterans care management health services research primary care
We would like to thank Lesa Powell and Teresa Hinton for their tireless efforts on behalf of the DISPO ED study, and our clinical advisory board members (Eleanor McConnell, William Knaack, Wendy Henderson, and Jorge Cortina) for their significant intellectual contributions to the research.
This work was supported by the United States (U.S.) Department of Veterans Affairs, Health Services Research and Development Service (IIR 12-052; HX000976A) and by the Center of Innovation to Accelerate Discovery and Practice Change (CIN 13-410) at the Durham VA Health Care System. KES also received support from the National Institute on Aging, Duke Claude D. Pepper Older Americans Independence Center, NIA P30AG028716.
Compliance with Ethical Standards
The Institutional Review Board of the Durham VA Health Care System (DVAHCS) approved this study.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.
- 1.Hastings SN, Smith VA, Weinberger M, Schmader KE, Olsen MK, Oddone EZ. Emergency department visits in Veterans Affairs medical facilities. Am J Manag Care. 2011;17(6 Spec No.):e215–223.Google Scholar
- 6.Morse L, Xiong L, Ramirez-Zohfeld V, Dresden S, Lindquist LA. Tele-follow-up of older adult patients from the Geriatric Emergency Department Innovation (GEDI) Program. Geriatrics (Basel). 2019;4(1).Google Scholar
- 9.Centers for Disease Control and Prevention. Measuring Healthy Days. 2000. Available at: http://www.cdc.gov/hrqol/pdfs/mhd.pdf. Accessed July 11, 2019.
- 14.Guttman A, Afilalo M, Guttman R, et al. An emergency department-based nurse discharge coordinator for elder patients: does it make a difference? Acad Emerg Med. 2004;11(12):1318–1327.Google Scholar
- 16.Lee JY, Muratov S, Tarride JE, Holbrook AM. Managing High-Cost Healthcare Users: The International Search for Effective Evidence-Supported Strategies. J Am Geriatr Soc 2018.Google Scholar
- 18.Hughes JM, Freiermuth CE, Shepherd-Banigan M, et al. Emergency Department Interventions for Older Adults: A Systematic Review. J Am Geriatr Soc. 2019.Google Scholar
- 19.Miller KEM, Duan-Porter W, Stechuchak KM, et al. Risk stratification for return emergency department visits among high-risk patients. Am J Manag Care. 2017;23(8):e275-e279.Google Scholar
- 20.National Quality Forum. Emergency department transitions of care: A quality measurement framework. 2017.Google Scholar
- 21.Chew LD, Bradley KA, Boyko EJ.. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588–594.Google Scholar