Beefing up post-discharge procedures, including using interactive voice monitoring technology, did not significantly reduce the number of patients with congestive heart failure or chronic obstructive pulmonary disease who were readmitted to the hospital or who visited emergency departments.

That’s the finding of a new study from the American Journal of Managed Care.

"A comprehensive hospital-based intervention failed to reduce 30- or 90-day readmissions as well as ED visits for patients with CHF or COPD, compared with usual care," authors Ariel Linden and Susan W. Butterworth concluded. "It did, however, reduce 90-day mortality among COPD patients. Our results suggest the need to continue to experiment with new interventions targeting readmissions — in particular, those focused on building collaborative relationships between hospitals and community-based providers. In the interim, our results point to a challenging road ahead for hospitals seeking to decrease readmissions for chronically ill patients and avoid financial penalties."

The enhanced post-discharge interventions compared to usual care included motivational interviewing sessions and an interactive voice response monitoring system that was used up to 30 days post-discharge. The intervention group included 253 of 512 total patients studied; the authors discovered that, while 90 percent of the group receiving the coaching and IVR technology accessed the IVR system at least once in the 30-day discharge period, only 90, or 40 percent, used it daily. Of the 227 participants who used the IVR at least once over the 30-day post discharge period, 72 (32 percent) experienced at least one acute event, with a total of 92 readmissions or ED visits.

Possible reasons for the interventions' lack of effect, the authors said, could have been because the intervention was poorly executed, or that the study cohort was sufficiently ill to begin with that even ongoing monitoring could not positively affect their health.

Indeed, a recent study indicated that only 10 percent of the acute care costs incurred in a cohort of high-cost Medicare patients, with clinical characteristics similar to those of the study population, were considered preventable, Linden and Butterworth said. "However, other studies have successfully reduced readmissions in chronically ill individuals using many of the same intervention components as those used in the current study."

The full study is available here.

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