Abstract
Background: A small number of patients are disproportionally readmitted to hospitals. The Complex High Admission Management Program (CHAMP) was established as a multidisciplinary program to improve continuity of care and reduce readmissions for frequently hospitalized patients. Objective: To compare hospital utilization metrics among patients enrolled in CHAMP and usual care. Design: Pragmatic randomized controlled trial. Participants: Inclusion criteria were as follows: 3 or more, 30-day inpatient readmissions in the previous year; or 2 inpatient readmissions plus either a referral or 3 observation admissions in previous 6 months. Interventions: Patients randomized to CHAMP were managed by an interdisciplinary team including social work, physicians, and pharmacists. The CHAMP team used comprehensive care planning and inpatient, outpatient, and community visits to address both medical and social needs. Control patients were randomized to usual care and contacted 18 months after initial identification if still eligible. Main Measures: Primary outcome was number of 30-day inpatient readmissions 180 days following enrollment. Secondary outcomes were number of hospital admissions, total hospital days, emergency department visits, and outpatient clinic visits 180 days after enrollment. Key Results: There were 75 patients enrolled in CHAMP, 76 in control. Groups were similar in demographic characteristics and baseline readmissions. At 180 days following enrollment, CHAMP patients had more inpatient 30-day readmissions [CHAMP incidence rate 1.3 (95% CI 0.9–1.8) vs. control 0.8 (95% CI 0.5–1.1), p=0.04], though both groups had fewer readmissions compared to 180 days prior to enrollment. We found no differences in secondary outcomes. Conclusions: Frequently hospitalized patients experienced reductions in utilization over time. Though most outcomes showed no difference, CHAMP was associated with higher readmissions compared to a control group, possibly due to consolidation of care at a single hospital. Future research should seek to identify subsets of patients with persistently high utilization for whom tailored interventions may be beneficial. Trial Registration: ClinicalTrials.gov identifier: NCT03097640; https://clinicaltrials.gov/ct2/show/NCT03097640.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1877-1884 |
| Number of pages | 8 |
| Journal | Journal of general internal medicine |
| Volume | 37 |
| Issue number | 8 |
| DOIs | |
| State | Published - Jun 2022 |
Funding
This study took place at Northwestern Memorial Hospital (NMH), a large, urban academic hospital that serves a diverse patient population in Chicago, IL. Started in 2015, CHAMP utilizes a relationship-based care model that seeks to improve care and reduce hospital readmissions for at-risk patients. At the time of this study, CHAMP consisted of two social workers (1.6 total full-time equivalent (FTE)), 2 physicians (0.6 total FTE), a program manager (0.1 FTE), data analyst (0.1 FTE), and pharmacy support from precepted residents provided by McGaw Medical Center, Chicago, IL. CHAMP is funded internally by NMH. The authors would like to acknowledge Luke Hansen, MD, and Suzanne Condon-Paskiewicz, LCSW, CCM, for their instrumental role in growing CHAMP. The authors also acknowledge Emily Wilson, MBA, MHA, Claire Knoten, PhD, Erin Lambers, PhD, MPH, and Shandu Foster, MA, for their administrative support during the trial. Finally, the authors thank Gary Noskin, MD, and Julie Creamer, MS, RN, for their ongoing institutional and financial support of CHAMP. The authors would like to acknowledge Luke Hansen, MD, and Suzanne Condon-Paskiewicz, LCSW, CCM, for their instrumental role in growing CHAMP. The authors also acknowledge Emily Wilson, MBA, MHA, Claire Knoten, PhD, Erin Lambers, PhD, MPH, and Shandu Foster, MA, for their administrative support during the trial. Finally, the authors thank Gary Noskin, MD, and Julie Creamer, MS, RN, for their ongoing institutional and financial support of CHAMP.
Keywords
- care models
- care transitions
- continuity of care
- randomized controlled trial
- readmissions
ASJC Scopus subject areas
- Internal Medicine