Using a Decision Support Algorithm for Referrals to Post-Acute Care.
Kathryn H Bowles, Sarah J Ratcliffe, John H Holmes and 6 others
PMID 30414821WHAT IT FOUND
Post-acute care referral rates did not change significantly, but use of the decision-support algorithm was associated with lower readmission rates at same-day, 7-day, 14-day, and 30-day intervals.
Emergency department use did not change.
Key findings
01Post-acute care referral rates did not change significantly (59.5% versus 59.3%).
02Use of the decision-support algorithm was associated with significantly lower readmission rates across all measured time periods.
03Emergency department use did not differ significantly between the two study phases.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a before-and-after comparison, not a randomised trial, so differences between time periods could have affected the results. The study was done at only two hospitals using one discharge planning model. Referral was measured by discharge disposition code, so services that were offered but refused, or not executed because of eligibility, may not be counted. Readmission and emergency department outcomes were captured only at the study hospitals. Statistical adjustment could not remove unmeasured differences between the control and intervention cohorts. 455 patients had more than one qualifying stay and were included in both phases. Case managers were also trained and received twice-daily reports, so the contribution of any single component cannot be separated.
Declared interests
No conflicts of interest statement is included in the supplied text; the paper is listed as NIH extramural research support.
The easy way to misread this
Do not conclude the DIRECT algorithm alone caused the lower readmissions. This was a pre-post comparison, referral rates did not change significantly, and case managers were also trained and received twice-daily reports, so the contribution of any single component cannot be separated.