| Peer-Reviewed

Grand-Aides Markedly Reduce 6-Month and 30-Day Readmissions and Emergency Department Visits for Patients with Heart Failure: A Randomized Clinical Trial

Received: 19 April 2022     Accepted: 5 May 2022     Published: 12 May 2022
Views:       Downloads:
Abstract

While numerous approaches have been used to reducing hospital readmissions, few have been subjected to a randomized clinical trial (RCT). This RCT studied the effectiveness of a “Grand-Aides” home visitation program in the reduction of readmissions and emergency department (ED) visits for patients with heart failure. High-risk patients (N=97) were randomized to receive care either with Grand-Aides or an established program to reduce readmissions at one hospital over two years; 85% were covered by Medicare + Medicaid (“Dual Eligibles”). Grand-Aides patients had home visits, while the control patients received telephone follow-up from community health workers. Data on all-cause readmissions and all-cause ED visits were collected at 30 and 180 days. At 6 months: patients with Grand-Aides had a 60% reduction in all-cause 6-month readmissions (65% controls and 26% Grand-Aides), p<0.001, and a 67% reduction in all-cause emergency department visits (33% controls, 11% Grand-Aides), p<0.01. For readmissions in the first 30 days, patients with Grand-Aides had a 48% reduction in readmissions (42% controls, 21.7% Grand-Aides, p=0.03) and a 79% reduction in 30-day all-cause emergency. In the first randomized clinical trial on readmissions and ED, the Grand-Aides program showed significant reductions in patients with heart failure, as compared to the best available program at the time in our health system, suggesting the impact that regular tailored home visits can have on reducing hospital resource utilization and costs. Took out sections.

Published in Science Journal of Clinical Medicine (Volume 11, Issue 2)
DOI 10.11648/j.sjcm.20221102.11
Page(s) 40-44
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Readmissions, Emergency Department, Heart Failure, Grand-Aides, Cost Reduction, Care Management, Randomized CLINICAL Trial

References
[1] Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive Discharge Planning for the Hospitalized Elderly. Ann Intern Med [Internet]. 1994 Jun 15 [cited 2020 October 19]; 120 (12): 999. Available from: http://annals.org/article.aspx?doi=10.7326/0003-4819-120-12-199406150-00005
[2] Condon C, Lycan S, Duncan P, Bushnell C. Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program. Stroke [Internet]. 2016 Jun [cited 2020 October 19]; 47 (6): 1599–604. Available from: https://www.ahajournals.org/doi/10.1161/STROKEAHA.115.012524
[3] Phillips RA. America’s healthcare transformation : strategies and innovations [Internet]. [cited 2020 October 19]. Available from: https://www.jstor.org/stable/j.ctt1c3snkz
[4] Stauffer BD, Fullerton C, Fleming N, Ogola G, Herrin J, Pamala; Stafford M, Ballard DJ. HEALTH CARE REFORM Effectiveness and Cost of a Transitional Care Program for Heart Failure A Prospective Study With Concurrent Controls [Internet]. [cited 2020 October 19]. Available from: www.archinternmed.com
[5] Katz MH. Interventions to Decrease Hospital Readmission Rates. Arch Intern Med [Internet]. 2011 Jul 25 [cited 2020 October 19]; 171 (14): 1230. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinternmed.2011.309
[6] Thomas SC, Greevy RA, Garson A. Effect of Grand-Aides Nurse Extenders on Readmissions and Emergency Department Visits in Medicare Patients With Heart Failure. Am J Cardiol [Internet]. 2018 Jun 1 [cited 2020 October 19]; 121 (11): 1336–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29627108
[7] Grand-Aides USA. Grand-Aides program [Internet]. Available from: www.Grand-Aides.com
[8] Sealed envelope. Blinding and allocation concealment [cited 2020 October 19] Available from: https://www.sealedenvelope.com/randomisation/blinding/
[9] Hansen LO, Young RS, Hinami K, Leung A, Williams M V. Interventions to Reduce 30-Day Rehospitalization: A Systematic Review. Ann Intern Med [Internet]. 2011 Oct 18 [cited 2018 Dec 29]; 155 (8): 520. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22007045
[10] Kripalani S, Theobald CN, Anctil B, Vasilevskis EE. Reducing hospital readmission rates: current strategies and future directions. Ann Rev Med [Internet]. 2014 [cited 2020 October 19]; 65: 471–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24160939
[11] Coleman EA, Parry C, Chalmers S, Min S. The Care Transitions Intervention. Arch Intern Med [Internet]. 2006 Sep 25 [cited 2018 Dec 29]; 166 (17): 1822. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17000937
[12] Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O’Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med [Internet]. 2009 Feb 3 [cited 2018 Dec 29]; 150 (3): 178–87. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19189907
[13] Naylor MD, Bowles KH, McCauley KM, Maccoy MC, Maislin G, Pauly M V., Krakauer R. High-value transitional care: translation of research into practice. J Eval Clin Pract [Internet]. 2011 Apr [cited 2018 Dec 30]; 19 (5): no-no. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21410844
[14] McNeely J, McNealy K, Corey K, Simmerman J. Final Evaluation Report Evaluation of the Community-based Care Transitions Program Centers for Medicare &amp; Medicaid Services [Internet]. 2017 [cited 2018 Dec 30]. Available from: www.EconometricaInc.com
[15] Adams CJ, Stephens K, Whiteman K, Kersteen H, Katruska J. Implementation of the Re-Engineered Discharge (RED) Toolkit to Decrease All-Cause Readmission Rates at a Rural Community Hospital. Qual Manag Health Care [Internet]. 2014 [cited 2018 Dec 30]; 23 (3): 169–77. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24978166
[16] Study: Post-Discharge Phone Calls Reduce Hospital Readmissions [Internet]. [cited 2018 Dec 30]. Available from: https://www.beckershospitalreview.com/quality/study-post-discharge-phone-calls-reduce-hospital-readmissions.html
[17] Avoidable Admissions for Long-Term Care Dual Eligibles Down 31% [Internet]. [cited 2018 Dec 29]. Available from: https://healthitanalytics.com/news/avoidable-admissions-for-long-term-care-dual-eligibles-down-31
[18] Ong MK, Romano PS, Edgington S, Aronow HU, Auerbach AD, Black JT, De Marco T, Escarce JJ, Evangelista LS, Hanna B, Ganiats TG, Greenberg BH, Greenfield S, Kaplan SH, Kimchi A, Liu H, Lombardo D, Mangione CM, Sadeghi B, Sadeghi B, Sarrafzadeh M, Tong K, Fonarow GC. Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure. JAMA Intern Med [Internet]. 2016 Mar 1 [cited 2018 Dec 29]; 176 (3): 310. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2015.7712
[19] Pekmezaris R, Tortez L, Williams M, Patel V, Makaryus A, Zeltser R, Sinvani L, Wolf-Klein G, Lester J, Sison C, Lesser M, Kozikowski A. Home Telemonitoring In Heart Failure: A Systematic Review And Meta-Analysis. Health Aff [Internet]. 2018 Dec 3 [cited 2019 Jan 3]; 37 (12): 1983–9. Available from: http://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05087
[20] Telemedicine: Using Remote Monitoring to Reduce Hospital Readmissions - Blog [Internet]. [cited 2018 Dec 29]. Available from: https://mha.gwu.edu/blog/telemedicine-reduce-hospital-readmissions/
[21] Mayo Clinic study finds app reduces cardiac readmissions by 40 percent | Mobi Health News [Internet]. [cited 2018 Dec 29]. Available from: https://www.mobihealthnews.com/31580/mayo-clinic-study-finds-app-reduces-cardiac-readmissions-by-40-percent
[22] Mobile apps helping reduce readmissions | Healthcare IT News [Internet]. [cited 2018 Dec 29]. Available from: https://www.healthcareitnews.com/news/mobile-apps-helping-reduce-readmissions
[23] Leppin AL, Gionfriddo MR, Kessler M, Brito JP, Mair FS, Gallacher K, Wang Z, Erwin PJ, Sylvester T, Boehmer K, Ting HH, Murad MH, Shippee ND, Montori VM. Preventing 30-Day Hospital Readmissions. JAMA Intern Med [Internet]. 2014 Jul 1 [cited 2018 Dec 29]; 174 (7): 1095. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.1608
[24] Garson A, Green D, Rodriguez, L, Beech, R, Nye C. A new corps of trained Grand-Aides has the potential to extend reach of primary care workforce and save money. Health Aff [Internet] 2012 May [cited 2018 Dec 24]. Available from https://www.healthaffairs.org/doi/10.1377/hlthaff.2011.0859
[25] Hu J, Gonsahn MD, Nerenz, DR. Socioeconomic Status And Readmissions: Evidence From An Urban Teaching Hospital. Health Aff [Internet] 2014 [cited 2020 October 19] Available from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.0816
Cite This Article
  • APA Style

    Kathleen Reeves, Nicolle Strand, Byron Udegbe, Bryson Hoover-Hankerson, Steuart Wright, et al. (2022). Grand-Aides Markedly Reduce 6-Month and 30-Day Readmissions and Emergency Department Visits for Patients with Heart Failure: A Randomized Clinical Trial. Science Journal of Clinical Medicine, 11(2), 40-44. https://doi.org/10.11648/j.sjcm.20221102.11

    Copy | Download

    ACS Style

    Kathleen Reeves; Nicolle Strand; Byron Udegbe; Bryson Hoover-Hankerson; Steuart Wright, et al. Grand-Aides Markedly Reduce 6-Month and 30-Day Readmissions and Emergency Department Visits for Patients with Heart Failure: A Randomized Clinical Trial. Sci. J. Clin. Med. 2022, 11(2), 40-44. doi: 10.11648/j.sjcm.20221102.11

    Copy | Download

    AMA Style

    Kathleen Reeves, Nicolle Strand, Byron Udegbe, Bryson Hoover-Hankerson, Steuart Wright, et al. Grand-Aides Markedly Reduce 6-Month and 30-Day Readmissions and Emergency Department Visits for Patients with Heart Failure: A Randomized Clinical Trial. Sci J Clin Med. 2022;11(2):40-44. doi: 10.11648/j.sjcm.20221102.11

    Copy | Download

  • @article{10.11648/j.sjcm.20221102.11,
      author = {Kathleen Reeves and Nicolle Strand and Byron Udegbe and Bryson Hoover-Hankerson and Steuart Wright and Victor Jegede and Susan Freeman and Jeffrey Slocum and Arthur Garson},
      title = {Grand-Aides Markedly Reduce 6-Month and 30-Day Readmissions and Emergency Department Visits for Patients with Heart Failure: A Randomized Clinical Trial},
      journal = {Science Journal of Clinical Medicine},
      volume = {11},
      number = {2},
      pages = {40-44},
      doi = {10.11648/j.sjcm.20221102.11},
      url = {https://doi.org/10.11648/j.sjcm.20221102.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20221102.11},
      abstract = {While numerous approaches have been used to reducing hospital readmissions, few have been subjected to a randomized clinical trial (RCT). This RCT studied the effectiveness of a “Grand-Aides” home visitation program in the reduction of readmissions and emergency department (ED) visits for patients with heart failure. High-risk patients (N=97) were randomized to receive care either with Grand-Aides or an established program to reduce readmissions at one hospital over two years; 85% were covered by Medicare + Medicaid (“Dual Eligibles”). Grand-Aides patients had home visits, while the control patients received telephone follow-up from community health workers. Data on all-cause readmissions and all-cause ED visits were collected at 30 and 180 days. At 6 months: patients with Grand-Aides had a 60% reduction in all-cause 6-month readmissions (65% controls and 26% Grand-Aides), p<0.001, and a 67% reduction in all-cause emergency department visits (33% controls, 11% Grand-Aides), p<0.01. For readmissions in the first 30 days, patients with Grand-Aides had a 48% reduction in readmissions (42% controls, 21.7% Grand-Aides, p=0.03) and a 79% reduction in 30-day all-cause emergency. In the first randomized clinical trial on readmissions and ED, the Grand-Aides program showed significant reductions in patients with heart failure, as compared to the best available program at the time in our health system, suggesting the impact that regular tailored home visits can have on reducing hospital resource utilization and costs. Took out sections.},
     year = {2022}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Grand-Aides Markedly Reduce 6-Month and 30-Day Readmissions and Emergency Department Visits for Patients with Heart Failure: A Randomized Clinical Trial
    AU  - Kathleen Reeves
    AU  - Nicolle Strand
    AU  - Byron Udegbe
    AU  - Bryson Hoover-Hankerson
    AU  - Steuart Wright
    AU  - Victor Jegede
    AU  - Susan Freeman
    AU  - Jeffrey Slocum
    AU  - Arthur Garson
    Y1  - 2022/05/12
    PY  - 2022
    N1  - https://doi.org/10.11648/j.sjcm.20221102.11
    DO  - 10.11648/j.sjcm.20221102.11
    T2  - Science Journal of Clinical Medicine
    JF  - Science Journal of Clinical Medicine
    JO  - Science Journal of Clinical Medicine
    SP  - 40
    EP  - 44
    PB  - Science Publishing Group
    SN  - 2327-2732
    UR  - https://doi.org/10.11648/j.sjcm.20221102.11
    AB  - While numerous approaches have been used to reducing hospital readmissions, few have been subjected to a randomized clinical trial (RCT). This RCT studied the effectiveness of a “Grand-Aides” home visitation program in the reduction of readmissions and emergency department (ED) visits for patients with heart failure. High-risk patients (N=97) were randomized to receive care either with Grand-Aides or an established program to reduce readmissions at one hospital over two years; 85% were covered by Medicare + Medicaid (“Dual Eligibles”). Grand-Aides patients had home visits, while the control patients received telephone follow-up from community health workers. Data on all-cause readmissions and all-cause ED visits were collected at 30 and 180 days. At 6 months: patients with Grand-Aides had a 60% reduction in all-cause 6-month readmissions (65% controls and 26% Grand-Aides), p<0.001, and a 67% reduction in all-cause emergency department visits (33% controls, 11% Grand-Aides), p<0.01. For readmissions in the first 30 days, patients with Grand-Aides had a 48% reduction in readmissions (42% controls, 21.7% Grand-Aides, p=0.03) and a 79% reduction in 30-day all-cause emergency. In the first randomized clinical trial on readmissions and ED, the Grand-Aides program showed significant reductions in patients with heart failure, as compared to the best available program at the time in our health system, suggesting the impact that regular tailored home visits can have on reducing hospital resource utilization and costs. Took out sections.
    VL  - 11
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Lenfest Center for Community Workforce Partnerships, Temple University Health System, Philadelphia, the United States

  • Center for Urban Bioethics, Lewis Katz School of Medicine, Philadelphia, the United States

  • Center for Urban Bioethics, Lewis Katz School of Medicine, Philadelphia, the United States

  • Center for Urban Bioethics, Lewis Katz School of Medicine, Philadelphia, the United States

  • Center for Urban Bioethics, Lewis Katz School of Medicine, Philadelphia, the United States

  • Center for Urban Bioethics, Lewis Katz School of Medicine, Philadelphia, the United States

  • ROffice of the Provost, Rush University, Chicago, the United States

  • Lenfest Center for Community Workforce Partnerships, Temple University Health System, Philadelphia, the United States

  • Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston, Houston, the United States

  • Sections