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

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


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 (N = 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, P = 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aftercare* / economics
  • Aftercare* / methods
  • Aftercare* / standards
  • Aged
  • Cohort Studies
  • Comorbidity
  • Continuity of Patient Care / organization & administration*
  • Cost Savings* / methods
  • Cost Savings* / statistics & numerical data
  • Female
  • Health Care Costs / statistics & numerical data
  • Health Services Research
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Patient Discharge* / economics
  • Patient Discharge* / standards
  • Patient Discharge* / statistics & numerical data
  • Patient Readmission* / economics
  • Patient Readmission* / statistics & numerical data
  • Patient-Centered Care / organization & administration
  • Quality Improvement
  • Rhode Island