PT  - JOURNAL ARTICLE
AU  - Suzanne E. Mitchell
AU  - Matthew Reichert
AU  - Jessica Martin Howard
AU  - Katherine Krizman
AU  - Alexa Bragg
AU  - Molly Huffaker
AU  - Kimberly Parker
AU  - Mary Cawley
AU  - Hannah Webb Roberts
AU  - Yena Sung
AU  - Jennifer Brown
AU  - Larry Culpepper
AU  - Howard J. Cabral
AU  - Brian W. Jack
TI  - Reducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial
AID  - 10.1370/afm.2801
DP  - 2022 May 01
TA  - The Annals of Family Medicine
PG  - 246--254
VI  - 20
IP  - 3
4099  - http://www.annfammed.org/content/20/3/246.short
4100  - http://www.annfammed.org/content/20/3/246.full
SO  - Ann Fam Med2022 May 01; 20
AB  - PURPOSE To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support.METHODS This is a randomized controlled trial of hospitalized patients with patient health questionnaire-9 score of 10 or more. We delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention including cognitive behavioral therapy, self-management support, and patient navigation. Primary outcomes were hospital readmission and reutilization rates at 30 and 90 days post discharge.RESULTS We randomized 709 participants (353 RED-D, 356 RED-only). At 90 days, 265 (75%) intervention participants had received at least 1 RED-D session (median 4). At 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission (9% vs 10%, incidence rate ratio [IRR] 0.92 [95% CI, 0.56-1.52]) or reutilization (27% vs 24%, IRR 1.14 [95% CI, 0.85-1.54]). The intention-to-treat analysis also showed no differences at 90 days in readmission (28% vs 21%, IRR 1.30 [95% CI, 0.95-1.78]) or reutilization (70% vs 57%, IRR 1.22 [95% CI, 1.01-1.49]). In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions (3% vs 10%, IRR 0.30 [95% CI, 0.07-0.84]) compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions (11% vs 21%, IRR 0.52 [95% CI, 0.27-0.92]). Intention-to-treat analysis showed no differences between study groups on secondary outcomes.CONCLUSIONS Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.