Abstract
OBJECTIVE: To examine whether use of a nurse case manager to coordinate postdischarge care would improve rates of follow-up, emergency department utilization, and unexpected readmission for general medicine patients.
DESIGN: Prospective cohort trial.
SETTING: Publicly supported, tertiary-care teaching hospital.
PATIENTS: Four hundred seventy-eight patients admitted to the general medicine service.
INTERVENTIONS: Use of a nurse case manager to provide discharge planning before hospital discharge and to arrange for postdischarge outpatient follow-up. Patients in the control group had discharge planning in the traditional (“usual care”) manner.
MEASUREMENTS AND MAIN RESULTS: The proportion of patients with scheduled outpatient appointments in the medical clinic and the proportion making clinic visits, emergency department visits, or with readmission to the hospital within 30 days following discharge. A significantly greater proportion of patients assigned to the nurse case manager intervention had appointments scheduled at the time of hospital discharge (63% vs 46%,p<.001), and made scheduled visits in the outpatient clinic (32% vs 23%,p<.03). Intervention group patients were especially more likely than control group patients to have definite follow-up appointments if they were discharged on weekends. Intervention and control group patients did not differ, however, in the rates of emergency department utilization (p=.52) or unexpected readmissions within 30 days of discharge (p=.11).
CONCLUSIONS: Use of a nurse case manager to coordinate outpatient follow-up prior to discharge improved the continuity of outpatient care for patients on a general medical service. The intervention had no effect on unexpected readmissions or emergency department utilization.
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Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial. Ann Intern Med. 1994;120:999–1006.
Brook RH, Appel FA, Avery C, Orman M, Stevenson RL. Effectiveness of inpatient follow-up care. N Engl J Med. 1972;285:1509–14.
Smith DM, Weinberger M, Katz BP, Moore PS. Postdischarge care and readmissions. Med Care. 1988;26:699–708.
Rich MW, Vinson JM, Sperry JC, et al. Prevention of readmission in elderly patients with congestive heart failure: results of a prospective, randomized pilot study. J Gen Intern Med. 1993;8:585–90.
Naylor M. Comprehensive discharge planning for hospitalized elderly: a pilot study. Nurs Res. 1990;39:156–61.
Mason WB, Bedwell CW, Vander Zwaag R, Runyan JW. Why people are hospitalized. A description of preventable factors leading to admission for medical illness. Med Care. 1980;18:147–63.
Miller LV, Goldstein J. More efficient care of diabetic patients in a county hospital setting. N Engl J Med. 1972;286:1388–91.
Twaddel AC, Sweet RH. Factors leading to preventable hospital admissions. Med Care. 1970;8:200–8.
Graham H, Livesley B. Can readmissions to a geriatric medical unit by prevented? Lancet. 1983;1:404–6.
Bigby J, Dunn J, Jen P, Landefeld CS, Komaroff AL. Assessing the preventability of emergency hospital admission. A method for evaluating the quality of medical care in a primary care facility. Am J Med. 1987;83:1031–6.
Wasson JH, Sauvigne AE, Mogielnicki RP, et al. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA. 1984;252:2413–7.
Weinberger M, Oddone E. Strategies to reduce hospital readmissions: a review. Qual Rev Bull. 1989;15:255–60.
Moher D, Weinberg A, Hanlon R, Runnalls K. Effects of a medical team coordinator on length of hospital stay. Can Med Assoc J. 1992;146:511–5.
Fitzgerald JF, Smith DM, Martin DK, Freedman JA, Katz BP. A case manager intervention to reduce readmissions. Arch Intern Med. 1994;154:1721–9.
World Health Organization (WHO). International Classification of Diseases, 9th Revision, Clinical Modification. Los Angeles, Calif: Practice Management Information Corp; 1991.
SAS for Windows. Cary, NC: SAS Institute; 1993.
Hoy EW, Curtis RE, Rice T. Change and growth in managed care. Health Aff. 1991;10:18–36.
Detsky AS, Sackett DL. When was a ‘negative’ clinical trial big enough? How many patients you needed depends on what you found. Arch Intern Med. 1985;145:709–12.
Evans RL, Headricks RD. Evaluating hospital discharge planning: a randomized clinical trial. Med Care. 1993;31:358–70.
Epstein LM, Avni A, Hoop C, Flug D. Evaluation of a program of aftercare for patients discharged from the hospital. Med Care. 1973;11:320–7.
Grumbach K, Keane D, Bindman A. Primary care and public emergency department overcrowding. Am J Public Health. 1993;83:372–8.
Shortliffe E, Hamilton T, Nororian E. The emergency room and the changing pattern of medical care. N Engl J Med. 1958;258:20–5.
Davidson S. Understanding the growth of emergency department utilization. Med Care. 1978;16:122–31.
Shesser R, Kirsch T, Smith J, Hirsch R. An analysis of emergency department use by patients with minor illness. Ann Emerg Med. 1991;20:743–8.
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Received from the Division of General Internal Medicine, Case Western Reserve University and the MetroHealth Medical Center, Cleveland, Ohio.
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Einstadter, D., Cebul, R.D. & Franta, P.R. Effect of a nurse case manager on postdischarge follow-up. J Gen Intern Med 11, 684–688 (1996). https://doi.org/10.1007/BF02600160
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DOI: https://doi.org/10.1007/BF02600160