An Electronic Health Record-Based Intervention to Increase Follow-Up Office Visits and Decrease Rehospitalization in Older Adults

• Autores: Jerry H. Gurwitz, Terry Field, Jessica Ogarek, Jennifer Tjia, S. L. Cutrona, Leslie R. Harrold, Shawn J. Gagne, Peggy Preusse, Jennifer L. Donovan, Abir O. Kanaan, George Reed, Lawrence Garber
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 62, Nº. 5, 2014, págs. 865-871
• Idioma: inglés
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• Resumen

  • Objectives: To assess the effect of an electronic health record�based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.

    Design: Randomized controlled trial.

    Setting: Large multispecialty group practice.

    Participants: Individuals aged 65 and older discharged from hospital to home.

    Intervention: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug�drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule a posthospitalization office visit.

    Measurements: An outpatient office visit with a primary care provider after discharge and rehospitalization within 30 days after discharge.

    Results: Of the 1,870 discharges in the intervention group, 27.7% had an office visit with a primary care provider within 7 days of discharge. Of the 1,791 discharges in the control group, 28.3% had an office visit with a primary care provider within 7 days of discharge. In the intervention group, 18.8% experienced a rehospitalization within the 30-day period after discharge, compared with 19.9% in the control group. The hazard ratio for an office visit with a primary care physician did not significantly differ between the intervention and control groups. The hazard ratio for rehospitalization in the 30-day period after hospital discharge in the intervention versus the control group was 0.94 (95% confidence interval = 0.81�1.1).

    Conclusion: This electronic health record�based intervention did not have a significant effect on the timeliness of office visits to primary care providers after hospitalization or risk of rehospitalization.