Does increased access to primary care reduce hospital readmissions ?
For chronically ill patients, readmission to the hospital can be frequent and costly.
We studied the effect of an intervention designed to increase access to primary care after discharge from the hospital, with the goals of reducing readmissions and emergency department visits and increasing patients'quality of life and satisfaction with care.
In a multicenter randomized, controlled trial at nine Veterans Affairs Medical Centers, we randomly assigned 1396 veterans hospitalized with diabetes, chronic obstructive pulmonary disease, or congestive heart failure to receive either usual care or an intensive primary care intervention.
The intervention involved close follow-up by a nurse and a primary care physician, beginning before discharge and continuing for the next six months.
The patients were severely ill.
Half of those with congestive heart failure (504 patients) had disease in New York Heart Association class III or IV ; 30 percent of those with diabetes (751 patients) had end-organ damage ; and a quarter of those with chronic obstructive pulmonary disease (583 patients) required home oxygen treatment or oral corticosteroids.
The patients had extremely poor quality-of-life scores.
Although they received more intensive primary care than the controls, the patients in the intervention group had significantly higher rates of readmission (0.19 vs. 0.14 per month, P=0.005) and more days of rehospitalization (10.2 vs. 8.8, P=0.041)...
Mots-clés Pascal : Soin santé primaire, Hospitalisation, Qualité vie, Ancien combattant, Insuffisance cardiaque, Diabète, Bronchopneumopathie obstructive, Intervention, Vieillard, Homme, Etats Unis, Amérique du Nord, Amérique, Appareil circulatoire pathologie, Cardiopathie, Endocrinopathie, Appareil respiratoire pathologie, Poumon pathologie, Bronche pathologie
Mots-clés Pascal anglais : Primary health care, Hospitalization, Quality of life, Veteran, Heart failure, Diabetes mellitus, Obstructive pulmonary disease, Operation, Elderly, Human, United States, North America, America, Cardiovascular disease, Heart disease, Endocrinopathy, Respiratory disease, Lung disease, Bronchus disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0289853
Code Inist : 002B30A03B. Création : 199608.