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Discharge Information and Support for Patients Discharged from the Emergency Department: Results from a Randomized Controlled Trial

  • Susan N. HastingsEmail author
  • Karen M. Stechuchak
  • Cynthia J. Coffman
  • Elizabeth P. Mahanna
  • Morris Weinberger
  • Courtney H. Van Houtven
  • Kenneth E. Schmader
  • Cristina C. Hendrix
  • Chad Kessler
  • Jaime M. Hughes
  • Katherine Ramos
  • G. Darryl Wieland
  • Madeline Weiner
  • Katina Robinson
  • Eugene Oddone
Original Research

Abstract

Background

Little research has been done on primary care–based models to improve health care use after an emergency department (ED) visit.

Objective

To examine the effectiveness of a primary care–based, nurse telephone support intervention for Veterans treated and released from the ED.

Design

Randomized controlled trial with 1:1 assignment to telephone support intervention or usual care arms (ClinicalTrials.gov: NCT01717976).

Setting

Department of Veterans Affairs Health Care System (VAHCS) in Durham, NC.

Participants

Five hundred thirteen Veterans who were at high risk for repeat ED visits.

Intervention

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.

Main Measures

The primary outcome was repeat ED use within 30 days.

Key Results

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.

Conclusions

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.

Trials Registration

ClinicalTrials.gov NCT01717976.

KEY WORDS

randomized trials Veterans care management health services research primary care 

Notes

Acknowledgments

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.

Funding Information

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.

Disclaimer

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  • Susan N. Hastings
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  • Karen M. Stechuchak
    • 1
  • Cynthia J. Coffman
    • 1
    • 6
  • Elizabeth P. Mahanna
    • 1
  • Morris Weinberger
    • 1
    • 7
  • Courtney H. Van Houtven
    • 1
    • 5
  • Kenneth E. Schmader
    • 1
    • 2
    • 3
    • 4
  • Cristina C. Hendrix
    • 3
    • 9
  • Chad Kessler
    • 1
    • 2
  • Jaime M. Hughes
    • 1
    • 4
    • 5
  • Katherine Ramos
    • 1
    • 3
    • 4
    • 8
  • G. Darryl Wieland
    • 3
    • 4
  • Madeline Weiner
    • 3
  • Katina Robinson
    • 1
  • Eugene Oddone
    • 1
    • 2
  1. 1.Center of Innovation to Accelerate Discovery and Practice Transformation Durham VA Health Care SystemDurhamUSA
  2. 2.Department of MedicineDuke University School of MedicineDurhamUSA
  3. 3.Geriatric Research, Education, and Clinical CenterDurham VA Health Care SystemDurhamUSA
  4. 4.Center for the Study of Human Aging and DevelopmentDuke UniversityDurhamUSA
  5. 5.Department of Population Health SciencesDuke University School of MedicineDurhamUSA
  6. 6.Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamUSA
  7. 7.Department of Health Policy and ManagementUniversity of North Carolina at Chapel HillChapel HillUSA
  8. 8.Department of PsychiatryDuke University School of MedicineDurhamUSA
  9. 9.Duke University School of NursingDurhamUSA

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