Published in Population Health Management

Author(s): Patricia L. Harrison, MPH; Pamela A. Hara, BSN, MBA; James E. Pope, MD; Michelle C. Young, BS; and Elizabeth Y. Rula, PhD

Recurrent hospitalizations are responsible for considerable health care spending, although prior studies have shown that a substantial proportion of readmissions are preventable through effective discharge planning and patient follow-up after the initial hospital visit. This retrospective cohort study was undertaken to determine whether telephonic outreach to ensure patient understanding of and adherence to discharge orders following a hospitalization is effective at reducing hospital readmissions within 30 days after discharge. Claims data were analyzed from 30,272 members of a commercial health plan who were discharged from a hospital in 2008 to determine the impact of telephonic intervention on the reduction of 30-day readmissions. Members who received a telephone call within 14 days of discharge and were not readmitted prior to that call comprised the intervention group; all other members formed the comparison group. Multiple logistic regression was used to determine the impact of the intervention on 30-day readmissions, after adjusting for covariates. Results demonstrated that older age, male sex, and increased initial hospitalization length of stay were associated with an increased likelihood of readmission (P < 0.001). Receipt of a discharge call was associated with reduced rates of readmission; intervention group members were 23.1% less likely than the comparison group to be readmitted within 30 days of hospital discharge (P1⁄40.043). These findings indicate that timely discharge follow-up by telephone to supplement standard care is effective at reducing near-term hospital readmissions and, thus, provides a means of reducing costs for health plans and their members.

Key Takeaways:

  • The study tested whether telephonic outreach from a nurse — ensuring understanding of and adherence to discharge orders — reduced 30-day readmissions.
  • Patients who received a call from a Sharecare nurse within 14 days after discharge from the hospital were 23.1% less likely than the comparison group to have a 30-day readmission.
  • Timely telephonic follow-up after hospital discharge provides an effective way to improve
    quality measures and reduce the burden of readmissions.