Aiming to Improve Readmissions Through InteGrated Hospital Transitions (AIRTIGHT): a Pragmatic Randomized Controlled Trial

• Published in: Journal of general internal medicine : JGIM Vol. 34; no. 1; pp. 58 - 64
• Main Authors: McWilliams, Andrew, Roberge, Jason, Anderson, William E., Moore, Charity G., Rossman, Whitney, Murphy, Stephanie, McCall, Stephannie, Brown, Ryan, Carpenter, Shannon, Rissmiller, Scott, Furney, Scott
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-01-2019; Springer Nature B.V
• Subjects: Adult; Airtightness; Clinical trials; Crossovers; Emergency medical services; Female; Guidelines as Topic; Hospitals; Humans; Inpatients - statistics & numerical data; Internal Medicine; Intervention; Length of Stay - trends; Male; Medicine; Medicine & Public Health; Middle Aged; North Carolina; Original Research; Outcome Assessment, Health Care; Patient admissions; Patient Readmission - trends; Patients; Randomization; Retrospective Studies; Risk; Transitional Care - standards; Transitional Care - trends; North Carolina; readmissions; population health; outcomes research; healthcare value; pragmatic research
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-018-4617-1

Background
Despite years of intense focus, inpatient and observation readmission rates remain high and largely unchanged. Hospitals have little, robust evidence to guide the selection of interventions effective at reducing 30-day readmissions in real-world settings.
Objective
To evaluate if implementation of recent recommendations for hospital transition programs is effective at reducing 30-day readmissions in a population discharged to home and at high-risk for readmission.
Design
A non-blinded, pragmatic randomized controlled trial (
Clinicaltrials.gov
: NCT02763202) conducted at two hospitals in Charlotte, North Carolina.
Patients
A total of 1876 adult patients, under the care of a hospitalist, and at high risk for readmissions.
Intervention
Random allocation to a Transition Services (TS) program (
n
 = 935) that bridges inpatient, outpatient, and home settings, providing patients virtual and in-person access to a dedicated multidisciplinary team for 30-days, or usual care (
n
 = 941).
Main Measure
Thirty-day, unplanned, inpatient, or observation readmission rate.
Key Results
The 30-day readmission rate was 15.2% in the TS group and 16.3% in the usual care group (RR 0.93; 95% [CI, 0.76 to 1.15];
P
 = 0.52). There were no significant differences in readmissions at 60 and 90 days or in 30-day Emergency Department visit rates. Patients, who were referred to TS and readmitted, had less Intensive Care Unit admissions 15.5% vs. 26.8% (RR 0.74; 95% [CI, 0.59 to 0.93];
P
 = 0.02).
Conclusions
An intervention inclusive of contemporary recommendations does not reduce a high-risk population’s 30-day readmission rate. The high crossover to usual care (74.8%) reflects the challenge of non-participation that is ubiquitous in the real-world implementation of population health interventions.
Trial Registry
ClinicalTrials.gov
; registration ID number: NCT02763202, URL:
https://clinicaltrials.gov/ct2/show/NCT02763202