• Ariel Linden and Susan Butterworth.
• Linden Consulting Group, LLC, 1301 N Bay Dr, Ann Arbor, MI 48103. E-mail: alinden@lindenconsulting.org.
• Am J Manag Care. 2014 Oct 1; 20 (10): 783-92.

ObjectivesMedicare penalizes hospitals with 30-day readmissions above their expected rates. Hospitals have responded by implementing transitional care interventions; however, there is limited evidence to inform the development of a successful intervention.Study DesignParallel-group, stratified, randomized controlled trial.MethodsA total of 512 patients hospitalized at 2 community hospitals, with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), were randomly assigned to the intervention (n = 253) or usual care (n = 259). The intervention encompassed a 90-day hospital-based transitional care program. The primary end points were 30- and 90-day all-cause readmissions. Secondary measures included all-cause emergency department (ED) visits and mortality.ResultsOn average, study participants were 67 years of age, 57% female, and 70% insured by Medicare. There was no statistical difference between treatment groups on 30-day readmission incidence rates (difference, 0.040; 95% CI, -0.047 to 0.127; P = .36), or 90-day readmission incidence rates (difference of 0.035; 95% CI -0.122 to 0.192; P = .66). Groups also did not differ in ED visit incidence rates at 30 or 90 days. The mortality rate among patients with CHF showed no difference between groups (risk ratio = 0.90; 95% CI, 0.40-2.05). However, for COPD, mortality at 90 days was lower in the intervention group than in the usual care group (risk ratio = 0.28; 95% CI, 0.10-0.83).ConclusionsStand-alone community hospitals may be unable to prevent readmissions despite the use of comprehensive, evidence-based intervention components that are within their control. Better collaboration between hospitals and community-based providers is needed to ensure continuity of care for discharged patients.Trial RegistrationClinicalTrials.gov, Identifier: NCT01855022.

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