• Suzanne E Mitchell, Matthew Reichert, Jessica Martin Howard, Katherine Krizman, Alexa Bragg, Molly Huffaker, Kimberly Parker, Mary Cawley, Hannah Webb Roberts, Yena Sung, Jennifer Brown, Larry Culpepper, Howard J Cabral, and Brian W Jack.
• Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts Suzanne.Mitchell@bmc.org.
• Ann Fam Med. 2022 May 1; 20 (3): 246-254.

PurposeTo determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support.MethodsThis is a randomized controlled trial of hospitalized patients with patient health questionnaire-9 score of 10 or more. We delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention including cognitive behavioral therapy, self-management support, and patient navigation. Primary outcomes were hospital readmission and reutilization rates at 30 and 90 days post discharge.ResultsWe randomized 709 participants (353 RED-D, 356 RED-only). At 90 days, 265 (75%) intervention participants had received at least 1 RED-D session (median 4). At 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission (9% vs 10%, incidence rate ratio [IRR] 0.92 [95% CI, 0.56-1.52]) or reutilization (27% vs 24%, IRR 1.14 [95% CI, 0.85-1.54]). The intention-to-treat analysis also showed no differences at 90 days in readmission (28% vs 21%, IRR 1.30 [95% CI, 0.95-1.78]) or reutilization (70% vs 57%, IRR 1.22 [95% CI, 1.01-1.49]). In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions (3% vs 10%, IRR 0.30 [95% CI, 0.07-0.84]) compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions (11% vs 21%, IRR 0.52 [95% CI, 0.27-0.92]). Intention-to-treat analysis showed no differences between study groups on secondary outcomes.ConclusionsCare transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.© 2022 Annals of Family Medicine, Inc.

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