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J Gen Intern Med. 2014 Jun;29(6):878-84. doi: 10.1007/s11606-014-2814-0. Epub 2014 Mar 4.

Is implementation of the care transitions intervention associated with cost avoidance after hospital discharge?

Author information

1
Healthcentric Advisors, Providence, RI, USA.

Abstract

BACKGROUND:

Poorly-executed transitions out of the hospital contribute significant costs to the healthcare system. Several evidence-based interventions can reduce post-discharge utilization.

OBJECTIVE:

To evaluate the cost avoidance associated with implementation of the Care Transitions Intervention (CTI).

DESIGN:

A quasi-experimental cohort study using consecutive convenience sampling.

PATIENTS:

Fee-for-service Medicare beneficiaries hospitalized from 1 January 2009 to 31 May 2011 in six Rhode Island hospitals.

INTERVENTION:

The CTI is a patient-centered coaching intervention to empower individuals to better manage their health. It begins in-hospital and continues for 30 days, including one home visit and one to two phone calls.

MAIN MEASURES:

We examined post-discharge total utilization and costs for patients who received coaching (intervention group), who declined or were lost to follow-up (internal control group), and who were eligible, but not approached (external control group), using propensity score matching to control for baseline differences.

KEY RESULTS:

Compared to matched internal controls (Nā€‰=ā€‰321), the intervention group had significantly lower utilization in the 6 months after discharge and lower mean total health care costs ($14,729 vs. $18,779, Pā€‰=ā€‰0.03). The cost avoided per patient receiving the intervention was $3,752, compared to internal controls. Results for the external control group were similar. Shifting of costs to other utilization types was not observed.

CONCLUSIONS:

This analysis demonstrates that the CTI generates meaningful cost avoidance for at least 6 months post-hospitalization, and also provides useful metrics to evaluate the impact and cost avoidance of hospital readmission reduction programs.

PMID:
24590737
PMCID:
PMC4026506
DOI:
10.1007/s11606-014-2814-0
[Indexed for MEDLINE]
Free PMC Article

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