C2-1: A Randomized Controlled Trial of a Patient Navigator Intervention to Reduce Hospital Readmissions in a Safety Net Health Care System

Abstract

Background/AimsPoor care coordination at hospital discharge can result in avoidable hospital readmissions. This study's aim was to evaluate the effect of a community health worker (CHW) intervention, the Patient Navigator (PN), on readmission rates and post-discharge health care use in a safety net population.MethodsThis randomized controlled trial began in October 2011 among patients of Cambridge Health Alliance (CHA), an urban safety net health care system. We identified patients discharged from the medical service with lengths of stay 3 days or more, admission in the prior 6 months, age 60+ years, or admission for COPD or congestive heart failure. We randomized patients to the PN intervention or usual care alone. In the PN intervention, a bilingual hospital-based CHW engaged in discharge planning and made outreach phone calls to patients for 30 days after initial discharge and upon subsequent readmission. PNs assisted patients with follow-up appointments, obtaining and taking medications, transportation, financial barriers, and linkages to community resources. Sociodemographic, clinical, and utilization data were obtained from electronic medical records. Primary outcomes were the proportion of patients readmitted within 30 days, number of readmissions per patient, total number of hospital days within 180 days post-discharge, and proportion of patients with a primary care visit or an emergency department (ED) visit within 30 days. The trial will continue through spring 2013.ResultsAs of October 2012, 423 patients were in the PN group and 513 in the control group. Fewer PN patients (12.1%) were readmitted within 30 days of an index discharge than controls (13.6%). Readmissions per patient were lower in the PN group compared to controls (0.70 vs. 0.81), as were total hospital days (3.42 vs. 3.59). More PN patients than controls had a primary care visit within 30 days (77.1% vs. 68.6%), but similar percentages had an ED visit within 30 days (11.3% vs. 10.9%).ConclusionsPreliminary results show a trend toward a reduction in probability of 30-day readmission, number of readmissions, and total hospital days for safety net patients receiving a PN intervention, and a trend toward greater probability of a primary care visit within 30 days of discharge.