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Effect of the Hospital Elder Life Program on Risk of 30‐Day Readmission
Author(s) -
Rubin Fred H.,
Bellon Johanna,
Bilderback Andrew,
Urda Kevin,
Inouye Sharon K.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15132
Subject(s) - medicine , poisson regression , psychological intervention , confidence interval , retrospective cohort study , emergency medicine , cohort , cohort study , relative risk , delirium , odds ratio , intensive care medicine , nursing , population , environmental health
Objectives To compare rates of 30‐day readmission between hospital units with a Hospital Elder Life Program ( HELP ) and control units without HELP . Design Retrospective cohort study. Setting The study took place from July 1, 2013, to June 30, 2014, at the University of Pittsburgh Medical Center Shadyside, a 520‐bed community teaching hospital that has used HELP since 2002. Eight medical and surgical units with HELP were compared with 10 medical and surgical units without HELP . Participants During the study period, HELP units, had 4,794 patients aged 70 and older, and usual care units had 2,834. Intervention HELP is a multifactorial, multidisciplinary program that provides targeted interventions for delirium risk factors in at‐risk individuals in collaboration with bedside staff. Measurements Mixed‐effects Poisson regression models were used to estimate the adjusted incident risk ratio for 30‐day readmission between HELP and usual care units for the overall cohort and for the subgroup of individuals discharged home, with or without services. Results Patients on HELP units were more likely than those in usual care units to be older, female, and black and had an unadjusted readmission rate of 16.9%, versus 18.9% for patients on control units. The adjusted risk of readmission was 0.83 (95% confidence interval ( CI ) = 0.73–0.94, P = .003) for HELP unit patients overall and 0.74 (95% CI = 0.63–0.87, P < .001) for HELP unit patients discharged to home with or without services. Conclusion The HELP program is associated with lower risk of 30‐day hospital readmission overall and for the subgroup of individuals discharged to home. Prospective studies are needed to confirm these observations.