Page 547 - Encyclopedia of Nursing Research

514 n TRANSITIONAL CARE

showing reductions in preventable hospital- intervention group (intervention = $642,595
izations for primary and coexisting illnesses, vs. control = $1,238,928; p < .001). Time to first
T improvement in health outcomes after dis- readmission for any reason was increased in
charge, enhanced patient satisfaction, and the intervention group (log-ranked χ 1 = 11.1,
2
reduction in total hospital costs. p < .001; Naylor et al., 1999).
The first randomized clinical trial, con- The third clinical trial demonstrated
ducted in 1994, demonstrated that transitional potential for the TCM to decrease readmis-
care has the potential to decrease rehospital- sions or death, decrease mean total costs,
izations, number of hospital days, and total increase quality of care, and increase patient
charges among 276 older medical and surgi- satisfaction in 239 patients, ages 65 years and
cal cardiac patients aged 70 and older (Naylor older, hospitalized with heart failure (Naylor
et al., 1994). patients were randomized to et al., 2004). patients were randomized to
receive either a comprehensive discharge receive a 3-month advanced practice nurse–
planning protocol specifically developed for directed intervention or control group who
elders and implemented by geriatric clinical received routine patient management, dis-
specialists, or to a control group who received charge planning, and standard home agency
the hospital’s routine discharge plan. The care if referred. Time to first readmission or
results demonstrated that the intervention death was longer in intervention patients
medical patients had significantly decreased (log-ranked χ = 5.0, p = .026, Cox regression
2
readmissions during the first 6 weeks (95% incidence density ratio = 1.65, 95% confidence
confidence interval [CI] = 25% to –1%, p = .04). interval = 1.13–2.40). At 52 weeks, intervention
Total rehospitalization days were fewer for patients had fewer readmissions (104 vs. 162,
the medical intervention group than for p = .047) and lower mean total costs ($7636 vs.
the control group 2 weeks after discharge $12,481, p = .002). The intervention group also
(p = .002) and between 2 and 6 weeks after reported short-term improvements in over-
discharge (p = .01). Total charges for health all quality of life (2 weeks, p < .01; 12 weeks,
care services after discharge for the medical p < .05) and patient satisfaction (2 and
intervention patients were $295,598 less than 6 weeks, p < .001; Naylor et al., 2004).
the control group at 6 weeks (p = .02; Naylor Ongoing research is directed toward
et al., 1994). translating evidence into practice and extend-
Results generated from the second clini- ing transitional care into other populations.
cal trial suggested that the TCM significantly The team at the university of pennsylvania
decreased readmissions, hospital days, and has formed a partnership with leaders of the
costs among 363 medical or surgical hospi- Aetna Corporation to translate and integrate
talized elders ages 65 and over (Naylor et al., the TCM for use in everyday practice and
1999). patients were randomized to either promote widespread adoption of the model
an advanced practice nurse–centered dis- by demonstrating its effectiveness with a
charge planning and home follow-up inter- high-risk Medicare managed-care popula-
vention, or to a control group who received tion in the mid Atlantic region. The evidence
routine discharge planning. At 24 weeks, the from this partnership is currently in analysis.
intervention resulted in fewer total hospital The key lessons, however, from translating
readmissions after the index hospitalization research to practice, are the need to identify
(intervention = 49 vs. control = 107; rank sum strong champions, fit with the organization,
test, p < .001), decreased hospital days (inter- engage key stakeholders, remain flexible,
vention = 270 days vs. control = 760 days; assess and know the external climate, strat-
p < p < .001), and lower reimbursement costs egize the marketing of the innovation to
for readmissions, acute care visits, and home others, establish milestones, and measure
visits were significantly decreased in the success (Naylor et al., 2009).