RT Journal Article
SR Electronic
T1 Reducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 246
OP 254
DO 10.1370/afm.2801
VO 20
IS 3
A1 Mitchell, Suzanne E.
A1 Reichert, Matthew
A1 Howard, Jessica Martin
A1 Krizman, Katherine
A1 Bragg, Alexa
A1 Huffaker, Molly
A1 Parker, Kimberly
A1 Cawley, Mary
A1 Roberts, Hannah Webb
A1 Sung, Yena
A1 Brown, Jennifer
A1 Culpepper, Larry
A1 Cabral, Howard J.
A1 Jack, Brian W.
YR 2022
UL http://www.annfammed.org/content/20/3/246.abstract
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.