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https://hdl.handle.net/2440/8615
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dc.contributor.author | Stewart, S. | - |
dc.contributor.author | Vandenbroek, A. | - |
dc.contributor.author | Pearson, S. | - |
dc.contributor.author | Horowitz, J. | - |
dc.date.issued | 1999 | - |
dc.identifier.citation | Archives of Internal Medicine, 1999; 159(3):257-261 | - |
dc.identifier.issn | 0003-9926 | - |
dc.identifier.issn | 1538-3679 | - |
dc.identifier.uri | http://hdl.handle.net/2440/8615 | - |
dc.description.abstract | <h4>Background</h4>A single home-based intervention (HBI) applied immediately after hospital discharge in a cohort of "high-risk" patients with congestive heart failure has been shown to decrease numbers of unplanned readmissions plus out-of-hospital deaths during a period of 6 months. The duration of this beneficial effect remains uncertain.<h4>Methods</h4>Hospitalized patients with congestive heart failure who had been randomly assigned to receive either usual care (n=48) or HBI 1 week after discharge (n=49) were subject to an extended follow-up of 18 months. The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths. Secondary end points included total hospital stay, frequency of multiple readmissions, cost of hospital-based care, and total mortality.<h4>Results</h4>During 18-month follow-up, HBI patients had fewer unplanned readmissions (64 vs 125; P=.02) and out-of-hospital deaths (2 vs 9; P=.02), representing 1.4+/-1.3 vs 2.7+/-2.8 events per HBI and usual-care patient, respectively (P=.03). The HBI patients also had fewer days of hospitalization (2.5+/-2.7 vs 4.5+/-4.8 per patient; P=.004) and, once readmitted, were less likely to experience 4 or more readmissions (3/31 vs 12/38; P=.03). Hospital-based costs were significantly lower among HBI patients (Aust $5100 vs Aust $10600 per patient; P=.02). Unplanned readmission was positively correlated with 14 days or more of unplanned readmission in the 6 months before study entry (odds ratio [OR], 5.4; P=.006). Positive correlates of death were (1) non-English speaking (OR, 4.9; P=.008), (2) 14 days or more of unplanned readmission in the 6 months before study entry (OR, 4.9; P=.008), and (3) left ventricular ejection fraction of 40% or less (OR, 3.0; P=.03); conversely, assignment to HBI was a negative correlate (OR, 0.3; P=.02).<h4>Conclusions</h4>In this controlled study, among a cohort of high-risk patients with congestive heart failure, beneficial effects of a postdischarge HBI were sustained for at least 18 months, with a significant reduction in unplanned readmissions, total hospital stay, hospital-based costs, and mortality. | - |
dc.language.iso | en | - |
dc.publisher | AMER MEDICAL ASSOC | - |
dc.source.uri | http://dx.doi.org/10.1001/archinte.159.3.257 | - |
dc.subject | Humans | - |
dc.subject | Length of Stay | - |
dc.subject | Patient Readmission | - |
dc.subject | Analysis of Variance | - |
dc.subject | Odds Ratio | - |
dc.subject | Follow-Up Studies | - |
dc.subject | Adult | - |
dc.subject | Aged | - |
dc.subject | Aged, 80 and over | - |
dc.subject | Middle Aged | - |
dc.subject | Home Care Services, Hospital-Based | - |
dc.subject | Hospital Costs | - |
dc.subject | Australia | - |
dc.subject | Female | - |
dc.subject | Male | - |
dc.subject | Heart Failure | - |
dc.title | Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1001/archinte.159.3.257 | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Stewart, S. [0000-0001-9032-8998] | - |
dc.identifier.orcid | Horowitz, J. [0000-0001-6883-0703] | - |
Appears in Collections: | Aurora harvest Medicine publications |
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