Scaling care coordination through digital engagement: stepped-wedge trial assessing readmissions

• Published in: The American journal of managed care Vol. 30; no. 2; pp. e32 - e38
• Main Authors: Polovneff, Alexandra, Shah, Neemit, Janardan, Abhishek, Smith, Erika, Pasillas, Ivan, Mortensen, Natalie, Holt, Jeana M, Somai, Melek, Sparapani, Rodney, Crotty, Bradley
• Format: Journal Article
• Language: English
• Published: United States MultiMedia Healthcare Inc 01.02.2024
• Subjects: Aftercare; Automation; Beneficiaries; Continuity of care; COVID-19; Education; Emergency medical care; Health care access; Heart failure; Hospitalization; Hospitals; Humans; Inpatients; Nurses; Patient Discharge; Patient Readmission; Patients; Primary care
• ISSN: 1088-0224; 1936-2692; 1936-2692
• DOI: 10.37765/ajmc.2024.89498

Transitions of care are pivotal, vulnerable times as patients are discharged from the hospital. Telephonic care coordination is standard care, but labor intensive. We implemented a patient postdischarge digital engagement (PDDE) program to scale coordination. We hypothesized that PDDE could reduce readmissions for low-risk patients and supplement care coordination for medium- and high-risk patients. Pragmatic, stepped-wedge cluster randomization trial with 5 implementation waves based upon primary care clinic region. All inpatient hospital discharges between March 2020 and November 2020 were stratified by readmission risk. Low-risk patients were offered access to PDDE, and moderate-risk and high-risk patients were offered access to PDDE and care coordination. Readmission was defined as an unplanned inpatient admission within 30 days from discharge. An intention-to-treat primary analysis was conducted using mixed-effects logistic regression clustering for wave; a treatment-on-the-treated analysis was also conducted to assess the impact among program users. A total of 5490 patient discharges were examined (2735 control; 2755 intervention); 1949 patients were high risk, 2032 were medium risk, and 1509 were low risk. PDDE intervention did not significantly affect readmission among low-risk (95% CI, -0.23 to 0.90; P  = .23), medium-risk (95% CI, -0.14 to 0.60; P  = .21), and high-risk (95% CI, -0.32 to 0.64; P  = .48) groups after adjustment for time and patient factors. In a treatment-on-the-treated analysis, among patients who activated the PDDE program, readmission was also similar among the low-, medium-, and high-risk cohorts. Our study expanded resource-limited care coordination by offering low-risk patients a service they were unable to receive previously while having no impact on readmission. PDDE efficiently provided additional touch points between patients and providers.