A reengineered hospital discharge program to decrease rehospitalization: a randomized trial

Ann Intern Med. 2009 Feb 3;150(3):178-87. doi: 10.7326/0003-4819-150-3-200902030-00007.


Background: Emergency department visits and rehospitalization are common after hospital discharge.

Objective: To test the effects of an intervention designed to minimize hospital utilization after discharge.

Design: Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card.

Setting: General medical service at an urban, academic, safety-net hospital.

Patients: 749 English-speaking hospitalized adults (mean age, 49.9 years).

Intervention: A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment.

Measurements: Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers' follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment.

Results: Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed.

Limitation: This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report.

Conclusion: A package of discharge services reduced hospital utilization within 30 days of discharge.

Funding: Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute, National Institutes of Health.

Trial registration: ClinicalTrials.gov NCT00252057.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Boston
  • Cost Savings
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / standards*
  • Female
  • Hospitalization
  • Hospitals, University / economics
  • Hospitals, University / statistics & numerical data*
  • Hospitals, Urban / economics
  • Hospitals, Urban / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Care Team
  • Patient Discharge / standards*
  • Patient Education as Topic

Associated data

  • ClinicalTrials.gov/NCT00252057