Does a Complex Care Discharge Planning Initiative Reduce Unplanned Hospital Readmissions?
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 300,000
- 试验地点
- 1
- 主要终点
- Unplanned hospital readmission within 30 days
研究概览
简要总结
Unplanned hospital readmissions are associated with increases in morbidity, mortality, cost and patient dissatisfaction,. Policymakers continue to seek effective policy solutions to avoid readmissions in order to improve quality of care and reduce unnecessary expenditures,. One attempt to reduce readmissions was implemented on June 1 2012, when the Specialist Services Committee of British Columbia (a partnership of Doctors of BC and the Ministry of Health) introduced the new "G78717" fee code for physicians. The objective of the fee code was to create a financial incentive for physicians to provide a point-of-care supplemental discharge summary to patients and their primary care providers prior to discharge from hospital. Initially, only urgent hospital admissions were eligible for this incentive payment but on Nov 1 2015 the incentive was extended to include elective admissions as well. The other eligibility criteria remained unchanged.
The effectiveness and cost-effectiveness of the fee code intervention is unknown. This study will address important questions relevant to this policy intervention using rigorous methods and empirical data.
This study will employ two methods for measuring changes in readmission risk. First, we will use interrupted (multivariate) time series to measure whether there was a temporal change in provincial readmission risk associated with the implementation of the new fee code.
We will complement the above analyses with a stronger design, comparing hospitalizations for which the fee code was charged (intervention group) with a cohort of clinically similar hospitalizations for which the fee code was not charged (control group). For this approach, multivariate logistic regression will be the primary statistical method. Using this analytic strategy, 30-day readmission risk between the intervention and control group will be measured over time, adjusted for patient-, provider-, and hospitalization-level covariates.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •The study population will be comprised of all hospital discharges in British Columbia between 1 Jan 2002 and 30 June 2017.
排除标准
- •We will exclude separations with the following International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) codes as the Most Responsible Diagnosis:
- •Codes O00 - O99 [Pregnancy, childbirth and the puerperium]
- •Codes P00 - P96 [Certain conditions originating in the perinatal period]
结局指标
主要结局
Unplanned hospital readmission within 30 days
时间窗: 30 days
Unplanned hospital readmission within 30 days
次要结局
- Unplanned (urgent) hospital readmission within 1 year of index hospital discharge(1 year)
- Primary care visits within 30 days and 1 year of index hospital discharge(30 days and 1 year)
- Emergency department visit(30 days and 1 year)
- Use of transitional or stepdown care(30 days and 1 year)
- Death(30 days and 1 year)
- Improvements in appropriate population-level post-discharge prescription prevalence of an indicated medication(60 days)
- Improvements in appropriate population-level post-discharge prescription prevalence of a contraindicated medication(60 days)
研究者
John Staples
Clinical Assistant Professor
University of British Columbia