Using home coaching to support older adults with chronic illness after an emergency room visit / Donna L. Carden [and six others].

Format:

Book

Author/Creator:

Carden, Donna L., author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Language:

English

Subjects (All):

Chronic diseases.

Physical Description:

1 online resource (120 pages) : illustrations, maps.

Place of Publication:

Washington, D.C. : Patient-Centered Outcomes Research Institute (PCORI), 2019.

Summary:

BACKGROUND: Poorly managed emergency department (ED)-to-home transitions can lead to a cycle of repeated, costly, and preventable ED visits and hospitalizations. These outcomes are especially problematic for chronically ill older patients. Our team proposed the following question: Compared with usual post-ED care, can an intervention deployed after an ED visit that links chronically ill older adults with community-based support improve quality of life and reduce the need for additional ED visits and hospital admissions? OBJECTIVES: The objective of this application was to improve the health of Medicare beneficiaries with chronic illness by increasing the patient-centeredness of post-ED transitions. The central hypothesis was that an ED-to-home coaching intervention that links patients with community-based support would improve outcomes and help chronically ill older adults make informed health care decisions. We tested this hypothesis with 2 specific aims: 1. Specific Aim 1: Compare the effect of an Area Agency on Aging-based ED-to-home intervention against usual post-ED care on quality of life as well as prevention of subsequent ED visits and hospital admissions of chronically ill older patients.2. Specific Aim 2: Determine the extent to which the intervention, compared with usual post-ED care, helps chronically ill older patients make decisions about their health and use of health care services. METHODS: We employed a convergent mixed methods study design among chronically ill Medicare beneficiaries recruited from 2 EDs serving diverse populations and communities. A randomized controlled trial design evaluated patient-reported quality-of-life measures and health service use in participants exposed to either the coaching intervention or to usual post-ED care. The 30-day coaching intervention included 1 home visit, 3 follow-up phone calls, and other forms of support (eg, home-delivered meals, transportation to the doctor's office) as needed. The primary outcome was hospital-based care after index ED discharge (ED visits and hospital admissions). Other important outcomes included change in quality of life (informational support [ie, availability of helpful information or advice], anxiety, and physical function). In the qualitative component of the study, investigators recruited interview participants to reflect the overall study cohort. We determined if the intervention, compared with usual post-ED care, helped patients make decisions about their health and use of health care services. We applied a grounded theory approach and dimensional and thematic analysis to compare health care-seeking decisions in patient interviews. RESULTS: We recruited 1322 participants. Of participants assigned to the intervention, 58% experienced a coaching home visit. In both the intervention and usual care groups, patient-reported quality of life fell in the days following the ED visit, although the absolute decline in informational support was larger in the usual care compared with the intervention group. Self-reported anxiety and physical function worsened in the intervention compared with the usual care group. We observed no between-group changes in quality of life between baseline and up to 60-day follow-up. Coaching did not reduce the likelihood of return ED visits (odds ratio [OR] = 1.03; 95% CI, 0.79-1.34) or hospitalizations (OR = 0.96; 95% CI, 0.70-1.30) or increase outpatient visits (OR = 1.28; 95% CI, 0.96-1.71) compared with usual care. In-depth interviews with 40 patients and 10 physicians indicated that in both groups, patients' ED care seeking was rational and based on informed decision making and, often, provider advice. CONCLUSIONS: In chronically ill older adults, quality of life fell in the days following an ED visit. The coaching intervention did not significantly affect patients' quality of life compared with usual post-ED care. Moreover, the intervention did not reduce return ED visits or hospital admissions or increase outpatient visits compared with usual post-ED care. Regardless of assignment to the intervention or usual care group, patients' reasons for visiting the ED were rational, appropriate, and based on informed decision making. LIMITATIONS: We conducted the study only with Medicare beneficiaries and in EDs serving disadvantaged populations. Follow-up contact with patients was difficult and uptake of the coaching intervention was limited.

Contents:

Background

Participation of Patients and Other Stakeholders

Methods

Results

Discussion

Conclusions

REFERENCES

Related Publications

Acknowledgments

Appendices.

Notes:

Description based on publisher supplied metadata and other sources.