Reducing Emergency Room Visits and In-Hospitalizations by Implementing Best Practice for Transitional Care Using Innovative Technology and Big Data.
Sharon Hewner, Suzanne S Sullivan, Guan Yu
PMID 29569327WHAT IT FOUND
Hospitalizations did not clearly fall in the nurse-led care coordination pilot; emergency visits fell and outpatient visits rose.
Key findings
01In the 419-patient intervention practice, the hospitalization reduction was closest to statistical significance (p = .09), while emergency department and outpatient visit changes were statistically significant.
02In the regional Medicaid population (N = 38,612), inpatient, emergency and outpatient rate changes between 2014 and 2015 were statistically significant.
03Reduced inpatient and emergency encounters were estimated at $1,669 less per adult Medicaid recipient with chronic disease than expected from 2014 rates.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The intervention was implemented in one primary care practice, and the comparison practices were selected for technology and patient mix. The study was a before-and-after comparison, so it cannot show that the technology or nurse outreach alone caused the changes. The intervention practice had only 419 patients, and its inpatient rate reduction was closest to statistical significance (p = .09). Multiple concurrent interventions were in place in the region, and the authors used the regional Medicaid population to approximate secular trends. The health information exchange and clinical decision support tools were not a unified package and required extra steps by the care coordinator. The supplied text does not report funding or conflicts of interest.
Declared interests
No funding or conflicts of interest statement appears in the supplied text.
The easy way to misread this
Do not conclude that the nurse-led transitional care technology reduced hospitalizations. The hospitalization change in the 419-patient intervention practice was closest to statistical significance (p = .09), and emergency and outpatient rates also changed in comparison and regional Medicaid groups.