All Causes Hospital Admissions
Conditions
Brief summary
Residents of rural and frontier counties experience significant disparities in health care access and outcomes when compared to their urban counterparts. The organization of health care delivery contributes significantly to these disparities. For rural residents with multiple chronic conditions, transitioning along the continuum of care, between systems of treatment and support, and between dispersed locations present significant challenges. One critical challenge involves hospitalization for treatment because it requires travel to locations at a significant distance from home and disrupts personal and family routines. The transition back home is also problematic because discharge planning does not adequately account for limited access to care in rural areas. Indeed, discharge planning has been recently described as a black hole; fragmented and uncoordinated, and contributing to poor outcomes and patient dissatisfaction. The specific aim of this research is to ascertain rural patients' actual experience of the discharge planning process and to involve patients and rural providers in designing and testing a contextually appropriate rural options discharge model (ROADMAP) that improves patient outcomes and reduces re-hospitalizations.
Detailed description
Residents of rural counties experience significant disparities in health care access and outcomes when compared to their urban counterparts. These disparities are structural; based in our market-based medical care delivery system. For rural residents with multiple chronic conditions, transitioning along the continuum of care, between systems of treatment and support, and between dispersed locations both expose and produce disparities. The transition home from hospitalization for treatment exposes the current urban bias. Indeed, discharge planning is fragmented and uncoordinated, and contributes to poor the disparities. The specific aims of this research is to ascertain rural patients' actual experience of discharge; then to involve patients and rural providers in using those data to design a contextually appropriate rural options at discharge model of active planning (ROADMAP) that improves patient outcomes and reduces disparities. Objectives include: 1. Ascertain actual patient experience in the rural discharge process. 2. Design the ROADMAP model to fit the emerging health services context. 3. Test the ROADMAP's efficacy in enhancing patient defined outcomes. 4. Design the components for rapid diffusion. Researchers will work in four counties of the Missoula Hospital Referral Region with a total population of 53,116 living on 12,342 square miles (4.3 persons per square mile). Researchers will recruit patients seeking treatment from St. Patrick Hospital. Patients and patient advocates will serve on an Innovations Design Team (IDT) to create the ROADMAP. Researchers will first interview patients (n = 40) who have been discharged to one of the rural counties. Researchers will compare their experiences to guidelines. Next, they will conduct a Design Survey (n=600) to verify goals important to patients. The IDT will use these findings to develop design requirements for ROADMAP. Finally, we will use a quasi-experimental research design to compare the patient designed rural ROADMAP to standard practice. The primary outcome measures are measures that reflect the patient's values for health-related quality of life and functional status, as well as hospital re-admissions. An independent statistician will use Hierarchical Linear Modeling to examine the complex relationships. This approach accounts for patients nested in four counties and the correlated errors inherent in within subject analysis. Health care reform sets the occasion for rapid diffusion of ROADMAP. This can provide an incremental reduction in rural disparities. Incorporating patient and provider input increases the likelihood it will fit within the emerging reimbursement model. Researchers expect that ROADMAP will reduce re-hospitalizations by as much as 30%, and improve patient recovery and return to participation in daily life.
Interventions
BEHAVIORALEnhanced rural discharge and transition
While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient.
Sponsors
Providence St. Patrick Hospital, Missoula Montana
University of Montana
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Intervention model description
Patients were recruited from those admitted from one of four rural counties. In the initial phase, all patients enrolled from any county were assigned to a baseline condition. After enrollment stabilized, patients from one county were enrolled in the intervention while patients from the other three counties remained in baseline. Subsequently the intervention was introduced to the other counties sequentially while others remained in baseline. A return to baseline conditions followed a period after the intervention had been introduced in all counties.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Between 18 and 75 years of age * Admitted to St. Patrick regional referral hospital for treatment * Discharged home to one of four rural counties in Montana
Exclusion criteria
* Primary diagnosis involves psychiatric condition or substance abuse * Inmates of state prison * Admitted under ongoing criminal investigation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 3, 7, 14, 21, 30, 60, and 90 days after discharge | This reflects the proportion of patients who reported at least one visit to a their local primary care provider at 3, 7, 14, 21,30, 60, and 90 days after discharge. |
| Hospital Re-admissions Analyzed by Logistic Regression | 3, 7 ,14, 21, 30, 60, and 90 days after discharge | Proportion of patients who self-report at least one hospital readmission to any hospital after discharge from a regional hospital to one of four rural counties. |
| Emergency Department (ED) Visits Analyzed by Poisson Regression | 3, 7, 14, 21,30, 60, and 90 days after discharge | Number of self-reported visits to the emergency department of any hospital reported by patients after discharge from a regional hospital to one of four rural counties. |
| Emergency Department (D) Visits Analyzed by Logistic Regression | 3, 7, 14, 21,30, 60, and 90 days after discharge | Proportion of patients who report at least one emergency department visit after discharge from a regional hospital to one of four rural counties. |
| Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 3, 7, 14, 21, 30, 60, and 90 days after discharge | This reflects the number of visits to a patient's local primary care provider at 3, 7, 14, 21,30, 60, and 90 days after discharge. |
| Hospital Re-admissions Analyzed by Poisson Regression | 3, 7 ,14, 21, 30, 60, and 90 days after discharge | Number of admissions to any hospital reported by the patients after discharge from a regional hospital to one of four rural counties. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Short Form (SF12) Mental Health Score | 3, 7, 14, 21, 30, 60, and 90 days after discharge | The SF12 is a twelve-item standardized questionnaire that measures overall, physical health, and mental health. Patients rate each item on an ordinal scale. Data are analyzed using a proprietary algorithm. Scores range from 0 to 100. Higher scores reflect a better health status. The analysis creates an overall health score and sub scores that reflect physical health and mental health. Both Physical and Mental Health Composite Scales combine the 12 items in such a way that they compare to a national norm of a mean score of 50.0 and a standard deviation of 10.0. |
| Care Transition Measure (CTM3) | 3 days after discharge | The CTM3 is a three-item standardized questionnaire to measures patients' perspectives on coordination of hospital discharge care. Patients rate whether they strongly agree, agree, disagree, or strongly disagree with three items (hospital staff too my preferences into account, I had a good idea what I was responsible for once I left the hospital, and I clearly understood the purpose for taking each of my medications). They may also rate an items as not applicable to their situation. Ratings are converted to a scale that ranges from 0 to 100. Higher scores reflect better discharge care. |
| Rural Transition Measure (RTM14) | 7, 14, 21, 30, 60, and 90 days after discharge | The RTM14 is a fourteen-item questionnaire to measures patients' perspectives on the delivery of transition services and supports after discharge from a regional hospital to a small town or rural community. Patients respond by indicating whether they strongly disagree, disagree, agree, or strongly agree with each of the 14 items. Patients may also indicate whether an item is not applicable to their situation. Ratings are converted to a scale that ranges from 0 to 100. Higher scores reflect better transition service performance. |
| Short Form (SF12) Physical Health Score | 3, 7, 14, 21, 30, 60, and 90 days after discharge | The SF12 is a twelve-item standardized questionnaire that measures overall, physical health, and mental health. Patients rate each item on an ordinal scale. Data are analyzed using a proprietary algorithm. Scores range from 0 to 100. Higher scores reflect a better health status. The analysis creates an overall health score and sub scores that reflect physical health and mental health. Both Physical and Mental Health Composite Scales combine the 12 items in such a way that they compare to a national norm of a mean score of 50.0 and a standard deviation of 10.0. |
Participant flow
Recruitment details
We recruited participants from among patients admitted to Saint Patrick Hospital, a regional referral hospital, from one of four counties. All four were non-metropolitan counties and three of the counties met the criteria of being a frontier county (population of less than 6 people per square mile).
Participants by arm
| Arm | Count |
|---|---|
| Current Treatment Patients receive that current discharge planning services and supports. | 77 |
| Enhanced Transitions Planning The intervention consists of a package of procedures that enhances supports during the transitions from the hospital to recovery at home, including a structured needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of recovery supports to the patient.
Enhanced Transitions Planning: While in the treating hospital, patients from small towns and rural communities are engaged in package of procedures designed to improve the transitions home, including a functional needs assessment that produces a plan that matches available rural community service providers to a patient's transitions needs and the provision of enhanced recovery supports to the patient. | 50 |
| Total | 127 |
Baseline characteristics
| Characteristic | Enhanced Transitions Planning | Total | Current Treatment |
|---|---|---|---|
| Age, Continuous | 63.2 years | 61.2 years | 59.9 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 47 Participants | 119 Participants | 72 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 3 Participants | 8 Participants | 5 Participants |
| Length of Stay, Acuity, Co-morbidity, and Emergency Department Visits (LACE+) | 49.7 units on a scale | 46.3 units on a scale | 42.2 units on a scale |
| Patient Activation Measure (PAM10) | 73.8 units on a scale | 69.9 units on a scale | 65.1 units on a scale |
| Race (NIH/OMB) American Indian or Alaska Native | 6 Participants | 13 Participants | 7 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 3 Participants | 2 Participants |
| Race (NIH/OMB) White | 43 Participants | 110 Participants | 67 Participants |
| Region of Enrollment United States | 50 participants | 127 participants | 77 participants |
| Sex: Female, Male Female | 21 Participants | 55 Participants | 34 Participants |
| Sex: Female, Male Male | 29 Participants | 72 Participants | 43 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 2 / 77 | 0 / 50 |
| other Total, other adverse events | 0 / 77 | 0 / 50 |
| serious Total, serious adverse events | 0 / 77 | 0 / 50 |
Outcome results
Primary
Emergency Department (D) Visits Analyzed by Logistic Regression
Proportion of patients who report at least one emergency department visit after discharge from a regional hospital to one of four rural counties.
Time frame: 3, 7, 14, 21,30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Standard Hospital Discharge Services | Emergency Department (D) Visits Analyzed by Logistic Regression | 14 days after discharge | 0.16 participants with at least one ED visit |
| Standard Hospital Discharge Services | Emergency Department (D) Visits Analyzed by Logistic Regression | 30 days after discharge | 0.24 participants with at least one ED visit |
| Standard Hospital Discharge Services | Emergency Department (D) Visits Analyzed by Logistic Regression | 7 days after discharge | 0.15 participants with at least one ED visit |
| Standard Hospital Discharge Services | Emergency Department (D) Visits Analyzed by Logistic Regression | 60 days after discharge | 0.29 participants with at least one ED visit |
| Standard Hospital Discharge Services | Emergency Department (D) Visits Analyzed by Logistic Regression | 21 days after discharge | 0.22 participants with at least one ED visit |
| Standard Hospital Discharge Services | Emergency Department (D) Visits Analyzed by Logistic Regression | 90 days after discharge | .29 participants with at least one ED visit |
| Standard Hospital Discharge Services | Emergency Department (D) Visits Analyzed by Logistic Regression | 3 days after discharge | 0.10 participants with at least one ED visit |
| Enhanced Discharge & Rural Transition Support | Emergency Department (D) Visits Analyzed by Logistic Regression | 90 days after discharge | 0.23 participants with at least one ED visit |
| Enhanced Discharge & Rural Transition Support | Emergency Department (D) Visits Analyzed by Logistic Regression | 3 days after discharge | 0.09 participants with at least one ED visit |
| Enhanced Discharge & Rural Transition Support | Emergency Department (D) Visits Analyzed by Logistic Regression | 7 days after discharge | 0.11 participants with at least one ED visit |
| Enhanced Discharge & Rural Transition Support | Emergency Department (D) Visits Analyzed by Logistic Regression | 14 days after discharge | 0.14 participants with at least one ED visit |
| Enhanced Discharge & Rural Transition Support | Emergency Department (D) Visits Analyzed by Logistic Regression | 21 days after discharge | 0.19 participants with at least one ED visit |
| Enhanced Discharge & Rural Transition Support | Emergency Department (D) Visits Analyzed by Logistic Regression | 30 days after discharge | 0.20 participants with at least one ED visit |
| Enhanced Discharge & Rural Transition Support | Emergency Department (D) Visits Analyzed by Logistic Regression | 60 days after discharge | 0.23 participants with at least one ED visit |
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 3; H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 3.p-value: 0.597Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 7; H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 7.p-value: 0.504Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 14; H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 14.p-value: 0.558Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 21; H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 21.p-value: 0.472Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 30; H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 30.p-value: 0.462Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 60; H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 60.p-value: 0.394Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 90; H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 90.p-value: 0.368Regression, Logistic
Primary
Emergency Department (ED) Visits Analyzed by Poisson Regression
Number of self-reported visits to the emergency department of any hospital reported by patients after discharge from a regional hospital to one of four rural counties.
Time frame: 3, 7, 14, 21,30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Standard Hospital Discharge Services | Emergency Department (ED) Visits Analyzed by Poisson Regression | 14 days after discharge | 27 Emergency Department Visits |
| Standard Hospital Discharge Services | Emergency Department (ED) Visits Analyzed by Poisson Regression | 30 days after discharge | 43 Emergency Department Visits |
| Standard Hospital Discharge Services | Emergency Department (ED) Visits Analyzed by Poisson Regression | 7 days after discharge | 18 Emergency Department Visits |
| Standard Hospital Discharge Services | Emergency Department (ED) Visits Analyzed by Poisson Regression | 60 days after discharge | 47 Emergency Department Visits |
| Standard Hospital Discharge Services | Emergency Department (ED) Visits Analyzed by Poisson Regression | 21 days after discharge | 38 Emergency Department Visits |
| Standard Hospital Discharge Services | Emergency Department (ED) Visits Analyzed by Poisson Regression | 90 days after discharge | 48 Emergency Department Visits |
| Standard Hospital Discharge Services | Emergency Department (ED) Visits Analyzed by Poisson Regression | 3 days after discharge | 9 Emergency Department Visits |
| Enhanced Discharge & Rural Transition Support | Emergency Department (ED) Visits Analyzed by Poisson Regression | 90 days after discharge | 21 Emergency Department Visits |
| Enhanced Discharge & Rural Transition Support | Emergency Department (ED) Visits Analyzed by Poisson Regression | 3 days after discharge | 6 Emergency Department Visits |
| Enhanced Discharge & Rural Transition Support | Emergency Department (ED) Visits Analyzed by Poisson Regression | 7 days after discharge | 11 Emergency Department Visits |
| Enhanced Discharge & Rural Transition Support | Emergency Department (ED) Visits Analyzed by Poisson Regression | 14 days after discharge | 17 Emergency Department Visits |
| Enhanced Discharge & Rural Transition Support | Emergency Department (ED) Visits Analyzed by Poisson Regression | 21 days after discharge | 19 Emergency Department Visits |
| Enhanced Discharge & Rural Transition Support | Emergency Department (ED) Visits Analyzed by Poisson Regression | 30 days after discharge | 19 Emergency Department Visits |
| Enhanced Discharge & Rural Transition Support | Emergency Department (ED) Visits Analyzed by Poisson Regression | 60 days after discharge | 19 Emergency Department Visits |
Comparison: H0: There is no difference in the cumulative number of hospital visits for day 3 (null hypothesis); H1: The cumulative number of hospital visits for the standard discharge group is greater than that for the enhanced discharge group for day 3.p-value: 0.502Poisson regression
Comparison: H0: There is no difference in the cumulative number of ED visits for day 7 (null hypothesis); H1: The cumulative number of ED visits for the standard discharge group is greater than that for the enhanced discharge group for day 7.p-value: 0.286Poisson regression
Comparison: H0: There is no difference in the cumulative number of ED visits for day 14 (null hypothesis); H1: The cumulative number of ED visits for the standard discharge group is greater than that for the enhanced discharge group for day 14.p-value: 0.347Poisson regression
Comparison: H0: There is no difference in the cumulative number of ED visits for day 21 (null hypothesis); H1: The cumulative number of ED visits for the standard discharge group is greater than that for the enhanced discharge group for day 21.p-value: 0.25Poisson regression
Comparison: H0: There is no difference in the cumulative number of ED visits for day 30 (null hypothesis); H1: The cumulative number of ED visits for the standard discharge group is greater than that for the enhanced discharge group for day 30.p-value: 0.22Poisson regression
Comparison: H0: There is no difference in the cumulative number of ED visits for day 60 (null hypothesis); H1: The cumulative number of ED visits for the standard discharge group is greater than that for the enhanced discharge group for day 60.p-value: 0.116Poisson regression
Comparison: H0: There is no difference in the cumulative number of ED visits for day 90 (null hypothesis); H1: The cumulative number of ED visits for the standard discharge group is greater than that for the enhanced discharge group for day 90.p-value: 0.126Poisson regression
Primary
Hospital Re-admissions Analyzed by Logistic Regression
Proportion of patients who self-report at least one hospital readmission to any hospital after discharge from a regional hospital to one of four rural counties.
Time frame: 3, 7 ,14, 21, 30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Logistic Regression | 14 days after discharge | 0.11 proportion of patients rehospitalized |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Logistic Regression | 30 days after discharge | 0.16 proportion of patients rehospitalized |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Logistic Regression | 7 days after discharge | 0.12 proportion of patients rehospitalized |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Logistic Regression | 60 days after discharge | 0.19 proportion of patients rehospitalized |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Logistic Regression | 21 days after discharge | 0.16 proportion of patients rehospitalized |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Logistic Regression | 90 days after discharge | 0.18 proportion of patients rehospitalized |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Logistic Regression | 3 days after discharge | 0.10 proportion of patients rehospitalized |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Logistic Regression | 90 days after discharge | 0.21 proportion of patients rehospitalized |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Logistic Regression | 3 days after discharge | 0.07 proportion of patients rehospitalized |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Logistic Regression | 7 days after discharge | 0.07 proportion of patients rehospitalized |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Logistic Regression | 14 days after discharge | 0.09 proportion of patients rehospitalized |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Logistic Regression | 21 days after discharge | 0.10 proportion of patients rehospitalized |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Logistic Regression | 30 days after discharge | 0.18 proportion of patients rehospitalized |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Logistic Regression | 60 days after discharge | 0.18 proportion of patients rehospitalized |
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 3 (null hypothesis); H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 3.p-value: 0.279Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 7 (null hypothesis); H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 7.p-value: 0.211Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 14 (null hypothesis); H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 14.p-value: 0.424Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 21 (null hypothesis); H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 21.p-value: 0.191Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 30 (null hypothesis); H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 30.p-value: 0.478Regression, Logistic
Comparison: H0: There is no difference in the proportion of patients with at least one ED visits by day 60 (null hypothesis); H1: The proportion of patients with at least one ED visit for the standard discharge group is greater than that for the enhanced discharge group for day 60.p-value: 0.452Regression, Logistic
p-value: 0.381Regression, Logistic
Primary
Hospital Re-admissions Analyzed by Poisson Regression
Number of admissions to any hospital reported by the patients after discharge from a regional hospital to one of four rural counties.
Time frame: 3, 7 ,14, 21, 30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Poisson Regression | 14 days after discharge | 23 Hospital Readmission |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Poisson Regression | 30 days after discharge | 25 Hospital Readmission |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Poisson Regression | 7 days after discharge | 21 Hospital Readmission |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Poisson Regression | 60 days after discharge | 28 Hospital Readmission |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Poisson Regression | 21 days after discharge | 25 Hospital Readmission |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Poisson Regression | 90 days after discharge | 26 Hospital Readmission |
| Standard Hospital Discharge Services | Hospital Re-admissions Analyzed by Poisson Regression | 3 days after discharge | 17 Hospital Readmission |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Poisson Regression | 90 days after discharge | 12 Hospital Readmission |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Poisson Regression | 3 days after discharge | 4 Hospital Readmission |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Poisson Regression | 7 days after discharge | 5 Hospital Readmission |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Poisson Regression | 14 days after discharge | 7 Hospital Readmission |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Poisson Regression | 21 days after discharge | 7 Hospital Readmission |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Poisson Regression | 30 days after discharge | 9 Hospital Readmission |
| Enhanced Discharge & Rural Transition Support | Hospital Re-admissions Analyzed by Poisson Regression | 60 days after discharge | 10 Hospital Readmission |
Comparison: H0: There is no difference in the cumulative number of hospital visits for day 3 (null hypothesis); H1: The cumulative number of hospital visits for the standard discharge group is greater than that for the enhanced discharge group for day 3.p-value: 0.03Poisson regression
Comparison: H0: There is no difference in the cumulative number of hospital visits for day 7 (null hypothesis); H1: The cumulative number of hospital visits for the standard discharge group is greater than that for the enhanced discharge group for day 7.p-value: 0.025Poisson regression
Comparison: H0: There is no difference in the cumulative number of hospital visits for day 14 (null hypothesis); H1: The cumulative number of hospital visits for the standard discharge group is greater than that for the enhanced discharge group for day 14.p-value: 0.037Poisson regression
Comparison: H0: There is no difference in the cumulative number of hospital visits for day 21 (null hypothesis); H1: The cumulative number of hospital visits for the standard discharge group is greater than that for the enhanced discharge group for day 21.p-value: 0.011Poisson regression
Comparison: H0: There is no difference in the cumulative number of hospital visits for day 30 (null hypothesis); H1: The cumulative number of hospital visits for the standard discharge group is greater than that for the enhanced discharge group for day 30.p-value: 0.05Poisson regression
Comparison: H0: There is no difference in the cumulative number of hospital visits for day 60 (null hypothesis); H1: The cumulative number of hospital visits for the standard discharge group is greater than that for the enhanced discharge group for day 60.p-value: 0.055Poisson regression
Comparison: H0: There is no difference in the cumulative number of hospital visits for day 90 (null hypothesis); H1: The cumulative number of hospital visits for the standard discharge group is greater than that for the enhanced discharge group for day 90.p-value: 0.137Poisson regression
Primary
Primary Care Provider (PCP) Visits Analyzed by Logistic Regression
This reflects the proportion of patients who reported at least one visit to a their local primary care provider at 3, 7, 14, 21,30, 60, and 90 days after discharge.
Time frame: 3, 7, 14, 21, 30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to a regional referral hospital for treatment, who enrolled in the study and were discharged to one of four rural counties.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 14 days after discharge | 0.47 Proportion with Primary Care Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 30 days after discharge | 0.63 Proportion with Primary Care Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 7 days after discharge | 0.31 Proportion with Primary Care Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 60 days after discharge | 0.74 Proportion with Primary Care Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 21 days after discharge | 0.60 Proportion with Primary Care Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 90 days after discharge | 0.80 Proportion with Primary Care Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 3 days after discharge | 0.07 Proportion with Primary Care Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 90 days after discharge | 0.70 Proportion with Primary Care Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 3 days after discharge | 0.05 Proportion with Primary Care Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 7 days after discharge | 0.32 Proportion with Primary Care Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 14 days after discharge | 0.51 Proportion with Primary Care Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 21 days after discharge | 0.53 Proportion with Primary Care Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 30 days after discharge | 0.55 Proportion with Primary Care Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Logistic Regression | 60 days after discharge | 0.64 Proportion with Primary Care Visits |
Comparison: : H0: There is no difference in the cumulative number of PCP visits for day 3 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 3.p-value: 0.717Regression, Logistic
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 7 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 7.p-value: 0.479Regression, Logistic
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 14 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 14.p-value: 0.329Regression, Logistic
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 21 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 21.p-value: 0.78Regression, Logistic
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 30 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 30.p-value: 0.779Regression, Logistic
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 60 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 60.p-value: 0.848Regression, Logistic
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 90 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 90.p-value: 0.857Regression, Logistic
Primary
Primary Care Provider (PCP) Visits Analyzed by Poisson Regression
This reflects the number of visits to a patient's local primary care provider at 3, 7, 14, 21,30, 60, and 90 days after discharge.
Time frame: 3, 7, 14, 21, 30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to a regional referral hospital for treatment, who enrolled in the study and were discharged to one of four rural counties.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 14 days after discharge | 54 Primary Care Provider Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 30 days after discharge | 91 Primary Care Provider Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 7 days after discharge | 27 Primary Care Provider Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 60 days after discharge | 135 Primary Care Provider Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 21 days after discharge | 71 Primary Care Provider Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 90 days after discharge | 148 Primary Care Provider Visits |
| Standard Hospital Discharge Services | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 3 days after discharge | 7 Primary Care Provider Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 90 days after discharge | 83 Primary Care Provider Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 3 days after discharge | 2 Primary Care Provider Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 7 days after discharge | 19 Primary Care Provider Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 14 days after discharge | 45 Primary Care Provider Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 21 days after discharge | 50 Primary Care Provider Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 30 days after discharge | 49 Primary Care Provider Visits |
| Enhanced Discharge & Rural Transition Support | Primary Care Provider (PCP) Visits Analyzed by Poisson Regression | 60 days after discharge | 59 Primary Care Provider Visits |
Comparison: The following hypotheses were tested: H0: There is no difference in the cumulative number of PCP visits for day 3 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 3.p-value: 0.946Poisson regression
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 7 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 7.p-value: 0.613Poisson regression
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 14 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 14.p-value: 0.541Poisson regression
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 21 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 21.p-value: 0.765Poisson regression
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 30 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 30.p-value: 0.919Poisson regression
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 60 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 60.p-value: 0.999Poisson regression
Comparison: H0: There is no difference in the cumulative number of PCP visits for day 90 (null hypothesis); H1: The cumulative number of PCP visits for the standard discharge group is less than that for the enhanced discharge group for day 90.p-value: 0.995Poisson regression
Secondary
Care Transition Measure (CTM3)
The CTM3 is a three-item standardized questionnaire to measures patients' perspectives on coordination of hospital discharge care. Patients rate whether they strongly agree, agree, disagree, or strongly disagree with three items (hospital staff too my preferences into account, I had a good idea what I was responsible for once I left the hospital, and I clearly understood the purpose for taking each of my medications). They may also rate an items as not applicable to their situation. Ratings are converted to a scale that ranges from 0 to 100. Higher scores reflect better discharge care.
Time frame: 3 days after discharge
Population: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Standard Hospital Discharge Services | Care Transition Measure (CTM3) | 0.86 Survey Response Scores | Standard Deviation 0.18 |
| Enhanced Discharge & Rural Transition Support | Care Transition Measure (CTM3) | 0.80 Survey Response Scores | Standard Deviation 0.26 |
Comparison: The following hypotheses were tested: H0: There is no difference in the mean CTM3 score between the standard and enhanced discharge groups (null hypothesis); H1: Patients in the enhanced discharge group will have a higher mean CTM3 rating than patients in the standard discharge group.p-value: 0.806ANCOVA
Secondary
Rural Transition Measure (RTM14)
The RTM14 is a fourteen-item questionnaire to measures patients' perspectives on the delivery of transition services and supports after discharge from a regional hospital to a small town or rural community. Patients respond by indicating whether they strongly disagree, disagree, agree, or strongly agree with each of the 14 items. Patients may also indicate whether an item is not applicable to their situation. Ratings are converted to a scale that ranges from 0 to 100. Higher scores reflect better transition service performance.
Time frame: 7, 14, 21, 30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Standard Hospital Discharge Services | Rural Transition Measure (RTM14) | 7 days after discharge | 0.854 Survey Response Scores | Standard Deviation 0.173 |
| Standard Hospital Discharge Services | Rural Transition Measure (RTM14) | 14 days after discharge | 0.897 Survey Response Scores | Standard Deviation 0.131 |
| Standard Hospital Discharge Services | Rural Transition Measure (RTM14) | 21 days after discharge | 0.922 Survey Response Scores | Standard Deviation 0.118 |
| Standard Hospital Discharge Services | Rural Transition Measure (RTM14) | 30 days after discharge | 0.902 Survey Response Scores | Standard Deviation 0.133 |
| Standard Hospital Discharge Services | Rural Transition Measure (RTM14) | 60 days after discharge | 0.901 Survey Response Scores | Standard Deviation 0.12 |
| Standard Hospital Discharge Services | Rural Transition Measure (RTM14) | 90 days after discharge | 0.901 Survey Response Scores | Standard Deviation 0.163 |
| Enhanced Discharge & Rural Transition Support | Rural Transition Measure (RTM14) | 60 days after discharge | 0.924 Survey Response Scores | Standard Deviation 0.092 |
| Enhanced Discharge & Rural Transition Support | Rural Transition Measure (RTM14) | 7 days after discharge | 0.884 Survey Response Scores | Standard Deviation 0.149 |
| Enhanced Discharge & Rural Transition Support | Rural Transition Measure (RTM14) | 30 days after discharge | 0.895 Survey Response Scores | Standard Deviation 0.147 |
| Enhanced Discharge & Rural Transition Support | Rural Transition Measure (RTM14) | 14 days after discharge | 0.873 Survey Response Scores | Standard Deviation 0.161 |
| Enhanced Discharge & Rural Transition Support | Rural Transition Measure (RTM14) | 90 days after discharge | 0.911 Survey Response Scores | Standard Deviation 0.107 |
| Enhanced Discharge & Rural Transition Support | Rural Transition Measure (RTM14) | 21 days after discharge | 0.876 Survey Response Scores | Standard Deviation 0.158 |
Comparison: The following hypotheses were tested: H0: There is no difference in the mean RTM14 score between the standard and enhanced discharge groups (null hypothesis); H1: Patients in the enhanced discharge group will have a higher mean RTM14 rating than patients in the standard discharge group.p-value: 0.742ANOVA
Secondary
Short Form (SF12) Mental Health Score
The SF12 is a twelve-item standardized questionnaire that measures overall, physical health, and mental health. Patients rate each item on an ordinal scale. Data are analyzed using a proprietary algorithm. Scores range from 0 to 100. Higher scores reflect a better health status. The analysis creates an overall health score and sub scores that reflect physical health and mental health. Both Physical and Mental Health Composite Scales combine the 12 items in such a way that they compare to a national norm of a mean score of 50.0 and a standard deviation of 10.0.
Time frame: 3, 7, 14, 21, 30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Standard Hospital Discharge Services | Short Form (SF12) Mental Health Score | 60 days after discharge | 54.4 units on a scale | Standard Deviation 8.7 |
| Standard Hospital Discharge Services | Short Form (SF12) Mental Health Score | 7 days after discharge | 50.0 units on a scale | Standard Deviation 12.5 |
| Standard Hospital Discharge Services | Short Form (SF12) Mental Health Score | 30 days after discharge | 53.8 units on a scale | Standard Deviation 10 |
| Standard Hospital Discharge Services | Short Form (SF12) Mental Health Score | 14 days after discharge | 51.8 units on a scale | Standard Deviation 10.9 |
| Standard Hospital Discharge Services | Short Form (SF12) Mental Health Score | 21 days after discharge | 53.9 units on a scale | Standard Deviation 10.6 |
| Standard Hospital Discharge Services | Short Form (SF12) Mental Health Score | 90 days after discharge | 54.8 units on a scale | Standard Deviation 10.2 |
| Standard Hospital Discharge Services | Short Form (SF12) Mental Health Score | 3 days after discharge | 47.8 units on a scale | Standard Deviation 12.1 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Mental Health Score | 90 days after discharge | 54.4 units on a scale | Standard Deviation 9.2 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Mental Health Score | 30 days after discharge | 53.4 units on a scale | Standard Deviation 11 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Mental Health Score | 60 days after discharge | 53.6 units on a scale | Standard Deviation 8.9 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Mental Health Score | 3 days after discharge | 47.2 units on a scale | Standard Deviation 11.2 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Mental Health Score | 7 days after discharge | 49.3 units on a scale | Standard Deviation 13 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Mental Health Score | 14 days after discharge | 50.9 units on a scale | Standard Deviation 10.5 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Mental Health Score | 21 days after discharge | 54.5 units on a scale | Standard Deviation 10.5 |
Comparison: The following hypotheses were tested: Hoi: There is no difference in mean SF-12 Mental Health scores between the standard and enhanced discharge groups (null hypothesis); H1i: The mean SF-12 Mental Health scores differ between the standard and enhanced discharge groups.p-value: 0.232ANOVA
Secondary
Short Form (SF12) Physical Health Score
The SF12 is a twelve-item standardized questionnaire that measures overall, physical health, and mental health. Patients rate each item on an ordinal scale. Data are analyzed using a proprietary algorithm. Scores range from 0 to 100. Higher scores reflect a better health status. The analysis creates an overall health score and sub scores that reflect physical health and mental health. Both Physical and Mental Health Composite Scales combine the 12 items in such a way that they compare to a national norm of a mean score of 50.0 and a standard deviation of 10.0.
Time frame: 3, 7, 14, 21, 30, 60, and 90 days after discharge
Population: Patients between 18 and 75 years old admitted to regional referral hospital for treatment, who enrolled in study and were discharged to one of four rural counties
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Standard Hospital Discharge Services | Short Form (SF12) Physical Health Score | 14 days after discharge | 35.7 units on a scale | Standard Deviation 6.4 |
| Standard Hospital Discharge Services | Short Form (SF12) Physical Health Score | 30 days after discharge | 37.3 units on a scale | Standard Deviation 6 |
| Standard Hospital Discharge Services | Short Form (SF12) Physical Health Score | 7 days after discharge | 34.7 units on a scale | Standard Deviation 6.6 |
| Standard Hospital Discharge Services | Short Form (SF12) Physical Health Score | 60 days after discharge | 39.2 units on a scale | Standard Deviation 5.8 |
| Standard Hospital Discharge Services | Short Form (SF12) Physical Health Score | 21 days after discharge | 36.3 units on a scale | Standard Deviation 6.1 |
| Standard Hospital Discharge Services | Short Form (SF12) Physical Health Score | 90 days after discharge | 40.3 units on a scale | Standard Deviation 6 |
| Standard Hospital Discharge Services | Short Form (SF12) Physical Health Score | 3 days after discharge | 35.1 units on a scale | Standard Deviation 7.8 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Physical Health Score | 90 days after discharge | 39.9 units on a scale | Standard Deviation 6.1 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Physical Health Score | 3 days after discharge | 36.3 units on a scale | Standard Deviation 7.9 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Physical Health Score | 7 days after discharge | 35.1 units on a scale | Standard Deviation 7.5 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Physical Health Score | 14 days after discharge | 36.0 units on a scale | Standard Deviation 6.7 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Physical Health Score | 21 days after discharge | 36.4 units on a scale | Standard Deviation 5.9 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Physical Health Score | 30 days after discharge | 37.2 units on a scale | Standard Deviation 7.1 |
| Enhanced Discharge & Rural Transition Support | Short Form (SF12) Physical Health Score | 60 days after discharge | 39.0 units on a scale | Standard Deviation 6.5 |
Comparison: The following hypotheses were tested: Hoi: There is no difference in mean SF12 Physical Health scores between the standard and enhanced discharge groups (null hypothesis); H1i: The mean SF12 Physical Health scores differ between the standard and enhanced discharge groups.p-value: 0.371ANOVA