A comprehensive hospital-based intervention to reduce readmissions for chronically ill patients: a randomized controlled trial

Am J Manag Care. 2014 Oct;20(10):783-92.


Objectives: Medicare penalizes hospitals with 30-day readmissions above their expected rates. Hospitals have responded by implementing transitional care interventions; however, there is limited evidence to inform the development of a successful intervention.

Study design: Parallel-group, stratified, randomized controlled trial.

Methods: A total of 512 patients hospitalized at 2 community hospitals, with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), were randomly assigned to the intervention (n = 253) or usual care (n = 259). The intervention encompassed a 90-day hospital-based transitional care program. The primary end points were 30- and 90-day all-cause readmissions. Secondary measures included all-cause emergency department (ED) visits and mortality.

Results: On average, study participants were 67 years of age, 57% female, and 70% insured by Medicare. There was no statistical difference between treatment groups on 30-day readmission incidence rates (difference, 0.040; 95% CI, -0.047 to 0.127; P = .36), or 90-day readmission incidence rates (difference of 0.035; 95% CI -0.122 to 0.192; P = .66). Groups also did not differ in ED visit incidence rates at 30 or 90 days. The mortality rate among patients with CHF showed no difference between groups (risk ratio = 0.90; 95% CI, 0.40-2.05). However, for COPD, mortality at 90 days was lower in the intervention group than in the usual care group (risk ratio = 0.28; 95% CI, 0.10-0.83).

Conclusions: Stand-alone community hospitals may be unable to prevent readmissions despite the use of comprehensive, evidence-based intervention components that are within their control. Better collaboration between hospitals and community-based providers is needed to ensure continuity of care for discharged patients.

Trial registration: ClinicalTrials.gov, Identifier: NCT01855022.

Publication types

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

MeSH terms

  • Aged
  • Chronic Disease / therapy
  • Female
  • Heart Failure / therapy*
  • Hospitals, Community / methods
  • Hospitals, Community / statistics & numerical data
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data
  • Motivational Interviewing / methods
  • Patient Readmission / statistics & numerical data*
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Transitional Care* / organization & administration

Associated data

  • ClinicalTrials.gov/NCT01855022