Effects of Home‐Based Intervention on Unplanned Readmissions and Out‐of‐Hospital Deaths

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Abstract
OBJECTIVE: To determine the effect of a home‐based intervention (HBI) on the frequency of unplanned readmission and out‐of‐hospital death among patients discharged home from acute hospital care. DESIGN: A randomized controlled trial comparing HBI with usual care (UC). SETTING: A tertiary referral hospital servicing the northwestern region of Adelaide, South Australia. PARTICIPANTS: Medical and surgical patients (n = 762) discharged home after hospitalization. INTERVENTION: Home‐based intervention (n = 381) consisted of counseling of all patients before discharge followed by a single home visit (by a nurse and pharmacist) to those patients considered to be at high risk of readmission (n = 314) in order to optimize compliance with and knowledge of the treatment regimen, identify early clinical deterioration, and intensify follow‐up of such patients where appropriate. MEASUREMENTS: The primary endpoint was the number of unplanned readmissions plus out‐of‐hospital deaths over a 6‐month follow‐up period. RESULTS: During the study follow‐up, the major endpoint occurred most commonly in the UC group (217 vs 155 episodes: P < .001). Overall, the HBI group demonstrated fewer unplanned readmissions (154 vs 197: P = .022), out‐of‐hospital deaths (1 vs. 20: P < .001), total deaths (12 vs. 29: P = .006), emergency department attendances (236 vs 314: P < .001), and total days of hospitalization (1452 vs 1766: P < .001). There was a disproportionate reduction in multiple events among HBI patients (P = .035). Hospital‐based costs of health care during study follow‐up tended to be lower in the HBI group ($A2190 vs $A2680 per patient: P = .102). Mean cost of HBI was $A190 per patient visited, whereas other community‐based health care costs were similar for both groups. CONCLUSIONS: Among high‐risk patients discharged from acute hospital care, HBI is beneficial in limiting unplanned readmissions and reducing risk of out‐of‐hospital death. It may be particularly cost‐effective if applied selectively to patients with a history of frequent unplanned hospital admission.