Abstract
Objectives
Rehospitalization of nursing home (NH) residents is frequent, costly, potentially
avoidable and associated with diminished quality of life and poor survival. This study
aims to evaluate the impact and cost-effectiveness of the Regular Early Assessment
Post-Discharge (REAP) protocol of coordinated specialist geriatrician and nurse practitioner
visits on rates of rehospitalization, hospital length of stay, and emergency department
presentations for NH residents recently discharged from hospital.
Design
Prospective randomized controlled study of recently hospitalized NH residents.
Setting
Twenty-one of 24 eligible NHs within the geographical catchment area of St George
Hospital, a 650-bed university hospital in Sydney, Australia.
Participants
NH residents from eligible facilities admitted to St George Hospital's geriatric service
were enrolled prior to hospital discharge.
Intervention
REAP intervention of monthly coordinated specialist geriatrician and nurse practitioner
assessments within participants' NHs for 6 months following hospital discharge.
Measurements
Impact of the REAP intervention on hospital readmissions, hospital inpatient days,
emergency department utilization, general practitioner visits, investigations and
associated costs during the study intervention period.
Results
Forty-three NH residents were randomly allocated to REAP intervention (n = 22) or
control (n = 21) groups. The REAP intervention group had almost two-thirds fewer hospital
readmissions (P = .03; Cohen's d = 0.73) and half as many emergency department visits than controls.
Total costs were 50% lower in the REAP intervention group, with lower total hospital
inpatient (P = .04; Cohen's d = 0.63) and total emergency department (P = .04; Cohen's d = 0.65) costs.
Conclusion
Cost-effective reductions in the utilization of hospital-related services were demonstrated
following implementation of the REAP intervention for NH residents recently discharged
from hospital.
Keywords
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Article info
Publication history
Published online: February 03, 2018
Footnotes
The authors declare no conflicts of interest.
This work was funded through an Establishment Grant from the St George and Sutherland Medical Research Foundation. The South Eastern Sydney and Illawarra Health Service and the Dementia Centre for Research Collaboration at The University of New South Wales provided personnel and/or infrastructure support for the study. Sponsoring bodies played no role in any aspect of the study apart from provision of funding.
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