A New Multimodal Geriatric Discharge-Planning Intervention to Prevent Emergency Visits and Rehospitalizations of Older Adults: The Optimization of Medication in AGEd Multicenter Randomized Controlled Trial

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Abstract
Objectives To determine whether a new multimodal comprehensive discharge‐planning intervention would reduce emergency rehospitalizations or emergency department (ED) visits for very old inpatients. Design Six‐month prospective, randomized (Zelen design), parallel‐group, open‐label trial. Setting Six acute geriatric units (AGUs) in Paris and its surroundings. Participants Six hundred sixty‐five consecutive inpatients aged 70 and older (intervention group (IG) n = 317; control group (CG) n = 348). Intervention Intervention‐dedicated geriatricians different from those in the study centers implemented the intervention, which targeted three risk factors for preventable readmissions and consisted of three components: comprehensive chronic medication review, education on self‐management of disease, and detailed transition‐of‐care communication with outpatient health professionals. Measurements Emergency hospitalization or ED visit 3 and 6 months after discharge, as assessed by telephone calls to the participant, the caregiver, and the general practitioner and confirmed with the hospital administrative database. Results Twenty‐three percent of IG participants were readmitted to hospital or had an ED visit 3 months after discharge, compared with 30.5% of CG participants (P = .03); at 6 months, the proportions were 35.3% and 40.8%, respectively (P = .15). Event‐free survival was significantly higher in the IG at 3 months (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.53–0.97, P = .03) but not at 6 months (HR = 0.81, 95% CI = 0.64–1.04, P = .10). Conclusion This intervention was effective in reducing rehospitalizations and ED visits for very elderly participants 3 but not 6 months after their discharge from the AGU. Future research should investigate the effect of this intervention of transitional care in a larger population and in usual acute and subacute geriatric care.