S. Mitchell, Matthew Reichert, J. Howard, Katherine Krizman, Alexa Bragg, Molly Huffaker, Kimberly N Parker, Mary Cawley, Hannah Webb Roberts, Yena Sung, Jennifer Brown, L. Culpepper, H. Cabral, Brian W. Jack
{"title":"减少抑郁症状住院患者再入院:一项随机试验","authors":"S. Mitchell, Matthew Reichert, J. Howard, Katherine Krizman, Alexa Bragg, Molly Huffaker, Kimberly N Parker, Mary Cawley, Hannah Webb Roberts, Yena Sung, Jennifer Brown, L. Culpepper, H. Cabral, Brian W. Jack","doi":"10.1370/afm.2801","DOIUrl":null,"url":null,"abstract":"PURPOSE To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support. METHODS This 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. RESULTS We 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. CONCLUSIONS Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.","PeriodicalId":22305,"journal":{"name":"The Annals of Family Medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"3","resultStr":"{\"title\":\"Reducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial\",\"authors\":\"S. Mitchell, Matthew Reichert, J. Howard, Katherine Krizman, Alexa Bragg, Molly Huffaker, Kimberly N Parker, Mary Cawley, Hannah Webb Roberts, Yena Sung, Jennifer Brown, L. Culpepper, H. Cabral, Brian W. Jack\",\"doi\":\"10.1370/afm.2801\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"PURPOSE To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support. METHODS This 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. RESULTS We 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. CONCLUSIONS Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.\",\"PeriodicalId\":22305,\"journal\":{\"name\":\"The Annals of Family Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Annals of Family Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1370/afm.2801\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Annals of Family Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1370/afm.2801","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 3
摘要
目的:确定有抑郁症状的住院患者是否能从出院后抑郁治疗和护理过渡支持中获益。方法:本研究是一项随机对照试验,纳入患者健康问卷-9得分在10分及以上的住院患者。我们进行了重新设计出院(RED),并将参与者随机分为仅接受RED或接受RED for Depression (RED- d)的组,这是一项为期12周的出院后远程医疗干预,包括认知行为治疗、自我管理支持和患者导航。主要结局是出院后30天和90天的再入院率和再利用率。结果:我们随机分配了709名参与者(353名RED-D, 356名RED-only)。在第90天,265名(75%)干预参与者接受了至少1次RED-D治疗(中位数为4次)。在第30天,意向治疗分析显示,RED-D治疗与RED-D治疗在再入院(9% vs 10%,发病率比[IRR] 0.92 [95% CI, 0.56-1.52])或再利用率(27% vs 24%, IRR 1.14 [95% CI, 0.85-1.54])方面没有差异。意向治疗分析也显示,90天的再入院率(28%对21%,IRR 1.30 [95% CI, 0.95-1.78])或再使用率(70%对57%,IRR 1.22 [95% CI, 1.01-1.49])无差异。在治疗后的分析中,每增加一次RED-D治疗与30天和90天再入院的减少有关。在第30天,接受3次或以上治疗的104名参与者中,与对照组相比,再入院人数较少(3% vs 10%, IRR 0.30 [95% CI, 0.07-0.84])。在第90天,109名接受6次或更多疗程的参与者中,再入院人数较少(11%对21%,IRR 0.52 [95% CI, 0.27-0.92])。意向治疗分析显示两组在次要结局上没有差异。结论:充分采用RED-D干预措施,护理过渡支持和出院后抑郁治疗可减少计划外住院。
Reducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial
PURPOSE To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support. METHODS This 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. RESULTS We 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. CONCLUSIONS Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.