Effect of Intensive Interdisciplinary Transitional Care for High-Need, High-Cost Patients on Quality, Outcomes, and Costs

a Quasi-Experimental Study

James Bailey, Satya Surbhi, Jim Wan, Kiraat D. Munshi, Teresa Waters, Bonnie L. Binkley, Michael O. Ugwueke, Ilana Yonas

Research output: Contribution to journalArticle

Abstract

Background: Many health systems have implemented team-based programs to improve transitions from hospital to home for high-need, high-cost patients. While preliminary outcomes are promising, there is limited evidence regarding the most effective strategies. Objective: To determine the effect of an intensive interdisciplinary transitional care program emphasizing medication adherence and rapid primary care follow-up for high-need, high-cost Medicaid and Medicare patients on quality, outcomes, and costs. Design: Quasi-experimental study. Patients: Among 2235 high-need, high-cost Medicare and Medicaid patients identified during an index inpatient hospitalization in a non-profit health care system in a medically underserved area with complete administrative claims data, 285 participants were enrolled in the SafeMed care transition intervention, and 1950 served as concurrent controls. Interventions: The SafeMed team conducted hospital-based real-time screening, patient engagement, enrollment, enhanced discharge care coordination, and intensive home visits and telephone follow-up for at least 45 days. Main Measures: Primary difference‐in‐differences analyses examined changes in quality (primary care visits, and medication adherence), outcomes (preventable emergency visits and hospitalizations, overall emergency visits, hospitalizations, 30‐day readmissions, and hospital days), and medical expenditures. Key Results: Adjusted difference-in-differences analyses demonstrated that SafeMed participation was associated with 7% fewer hospitalizations (− 0.40; 95% confidence interval (CI), − 0.73 to − 0.06), 31% fewer 30-day readmissions (− 0.34; 95% CI, − 0.61 to − 0.07), and reduced medical expenditures ($− 8690; 95% CI, $− 14,441 to $− 2939) over 6 months. Improvements were limited to Medicaid patients, who experienced large, statistically significant decreases of 39% in emergency department visits, 25% in hospitalizations, and 79% in 30-day readmissions. Medication adherence was unchanged (+ 2.6%; 95% CI, − 39.1% to 72.9%). Conclusions: Care transition models emphasizing strong interdisciplinary patient engagement and rapid primary care follow-up can enable health systems to improve quality and outcomes while reducing costs among high-need, high-cost Medicaid patients.

Original languageEnglish (US)
Pages (from-to)1815-1824
Number of pages10
JournalJournal of General Internal Medicine
Volume34
Issue number9
DOIs
StatePublished - Sep 15 2019

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Medicaid
Hospitalization
Costs and Cost Analysis
Medication Adherence
Confidence Intervals
Patient Participation
Patient Transfer
Primary Health Care
Health Expenditures
Medicare
Medically Underserved Area
Emergencies
Patient Readmission
House Calls
Quality of Health Care
Health
Critical Care
Telephone
Non-Randomized Controlled Trials
Transitional Care

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Effect of Intensive Interdisciplinary Transitional Care for High-Need, High-Cost Patients on Quality, Outcomes, and Costs : a Quasi-Experimental Study. / Bailey, James; Surbhi, Satya; Wan, Jim; Munshi, Kiraat D.; Waters, Teresa; Binkley, Bonnie L.; Ugwueke, Michael O.; Yonas, Ilana.

In: Journal of General Internal Medicine, Vol. 34, No. 9, 15.09.2019, p. 1815-1824.

Research output: Contribution to journalArticle

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abstract = "Background: Many health systems have implemented team-based programs to improve transitions from hospital to home for high-need, high-cost patients. While preliminary outcomes are promising, there is limited evidence regarding the most effective strategies. Objective: To determine the effect of an intensive interdisciplinary transitional care program emphasizing medication adherence and rapid primary care follow-up for high-need, high-cost Medicaid and Medicare patients on quality, outcomes, and costs. Design: Quasi-experimental study. Patients: Among 2235 high-need, high-cost Medicare and Medicaid patients identified during an index inpatient hospitalization in a non-profit health care system in a medically underserved area with complete administrative claims data, 285 participants were enrolled in the SafeMed care transition intervention, and 1950 served as concurrent controls. Interventions: The SafeMed team conducted hospital-based real-time screening, patient engagement, enrollment, enhanced discharge care coordination, and intensive home visits and telephone follow-up for at least 45 days. Main Measures: Primary difference‐in‐differences analyses examined changes in quality (primary care visits, and medication adherence), outcomes (preventable emergency visits and hospitalizations, overall emergency visits, hospitalizations, 30‐day readmissions, and hospital days), and medical expenditures. Key Results: Adjusted difference-in-differences analyses demonstrated that SafeMed participation was associated with 7{\%} fewer hospitalizations (− 0.40; 95{\%} confidence interval (CI), − 0.73 to − 0.06), 31{\%} fewer 30-day readmissions (− 0.34; 95{\%} CI, − 0.61 to − 0.07), and reduced medical expenditures ($− 8690; 95{\%} CI, $− 14,441 to $− 2939) over 6 months. Improvements were limited to Medicaid patients, who experienced large, statistically significant decreases of 39{\%} in emergency department visits, 25{\%} in hospitalizations, and 79{\%} in 30-day readmissions. Medication adherence was unchanged (+ 2.6{\%}; 95{\%} CI, − 39.1{\%} to 72.9{\%}). Conclusions: Care transition models emphasizing strong interdisciplinary patient engagement and rapid primary care follow-up can enable health systems to improve quality and outcomes while reducing costs among high-need, high-cost Medicaid patients.",
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AU - Bailey, James

AU - Surbhi, Satya

AU - Wan, Jim

AU - Munshi, Kiraat D.

AU - Waters, Teresa

AU - Binkley, Bonnie L.

AU - Ugwueke, Michael O.

AU - Yonas, Ilana

PY - 2019/9/15

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N2 - Background: Many health systems have implemented team-based programs to improve transitions from hospital to home for high-need, high-cost patients. While preliminary outcomes are promising, there is limited evidence regarding the most effective strategies. Objective: To determine the effect of an intensive interdisciplinary transitional care program emphasizing medication adherence and rapid primary care follow-up for high-need, high-cost Medicaid and Medicare patients on quality, outcomes, and costs. Design: Quasi-experimental study. Patients: Among 2235 high-need, high-cost Medicare and Medicaid patients identified during an index inpatient hospitalization in a non-profit health care system in a medically underserved area with complete administrative claims data, 285 participants were enrolled in the SafeMed care transition intervention, and 1950 served as concurrent controls. Interventions: The SafeMed team conducted hospital-based real-time screening, patient engagement, enrollment, enhanced discharge care coordination, and intensive home visits and telephone follow-up for at least 45 days. Main Measures: Primary difference‐in‐differences analyses examined changes in quality (primary care visits, and medication adherence), outcomes (preventable emergency visits and hospitalizations, overall emergency visits, hospitalizations, 30‐day readmissions, and hospital days), and medical expenditures. Key Results: Adjusted difference-in-differences analyses demonstrated that SafeMed participation was associated with 7% fewer hospitalizations (− 0.40; 95% confidence interval (CI), − 0.73 to − 0.06), 31% fewer 30-day readmissions (− 0.34; 95% CI, − 0.61 to − 0.07), and reduced medical expenditures ($− 8690; 95% CI, $− 14,441 to $− 2939) over 6 months. Improvements were limited to Medicaid patients, who experienced large, statistically significant decreases of 39% in emergency department visits, 25% in hospitalizations, and 79% in 30-day readmissions. Medication adherence was unchanged (+ 2.6%; 95% CI, − 39.1% to 72.9%). Conclusions: Care transition models emphasizing strong interdisciplinary patient engagement and rapid primary care follow-up can enable health systems to improve quality and outcomes while reducing costs among high-need, high-cost Medicaid patients.

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