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A Randomized, Controlled Trial of an Intensive Community Nurse–Supported Discharge Program in Preventing Hospital Readmissions of Older Patients with Chronic Lung Disease

Authors

  • Timothy Kwok FRCP,

    1. From the *Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong KongDepartment of Medicine and Geriatrics, Shatin Hospital, Hong KongDepartment of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong§Department of Medicine and Geriatrics, Tai Po Hospital, Hong KongNethersole School of Nursing, Chinese University of Hong Kong, Hong Kong.
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  • Chor Ming Lum FRCP,

    1. From the *Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong KongDepartment of Medicine and Geriatrics, Shatin Hospital, Hong KongDepartment of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong§Department of Medicine and Geriatrics, Tai Po Hospital, Hong KongNethersole School of Nursing, Chinese University of Hong Kong, Hong Kong.
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  • Hok Shum Chan FRCP,

    1. From the *Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong KongDepartment of Medicine and Geriatrics, Shatin Hospital, Hong KongDepartment of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong§Department of Medicine and Geriatrics, Tai Po Hospital, Hong KongNethersole School of Nursing, Chinese University of Hong Kong, Hong Kong.
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  • Hon Ming Ma MSc, FCCP, FRCP,

    1. From the *Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong KongDepartment of Medicine and Geriatrics, Shatin Hospital, Hong KongDepartment of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong§Department of Medicine and Geriatrics, Tai Po Hospital, Hong KongNethersole School of Nursing, Chinese University of Hong Kong, Hong Kong.
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  • Diana Lee PhD,

    1. From the *Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong KongDepartment of Medicine and Geriatrics, Shatin Hospital, Hong KongDepartment of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong§Department of Medicine and Geriatrics, Tai Po Hospital, Hong KongNethersole School of Nursing, Chinese University of Hong Kong, Hong Kong.
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  • Jean Woo MD, FRCP

    1. From the *Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong KongDepartment of Medicine and Geriatrics, Shatin Hospital, Hong KongDepartment of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong§Department of Medicine and Geriatrics, Tai Po Hospital, Hong KongNethersole School of Nursing, Chinese University of Hong Kong, Hong Kong.
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  • Funded by a Health Services Research Committee/Health Care and Promotion Fund grant. Poster presentation at the American Geriatrics Society Annual Scientific Meeting, Baltimore, Maryland, 2003.

Address correspondence to Prof. Timothy Kwok, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. E-mail: tkwok@cuhk.edu.hk

Abstract

Objectives: To evaluate the effectiveness of an intensive community nurse (CN)-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease (CLD).

Design: Randomized, controlled trial.

Setting: Two acute hospitals in the same health region in Hong Kong.

Participants: One hundred fifty-seven hospitalized patients aged 60 and older with a primary diagnosis of CLD and at least one hospital admission in the previous 6 months.

Intervention: CNs made home visits within 7 days of discharge, then weekly for 4 weeks and monthly until 6 months. CNs coordinated closely with a geriatric or respiratory specialist in hospital. Subjects had telephone access to CNs during normal working hours from Monday to Saturday.

Measurements: The primary outcome was the rate of unplanned readmission within 6 months. The secondary outcomes were the rate of unplanned readmission within 28 days, number of unplanned readmissions, hospital bed days, accident and emergency room attendance, functional and psychosocial status, and caregiver burden.

Results: One hundred forty hospitalized patients completed the trial. Intervention group subjects had a higher rate of unplanned readmission within 6 months than control group subjects (76% vs 62%, P=.080, χ2 test). There was no significant group difference in any of the secondary outcomes except that intervention group subjects did better on social handicap scores.

Conclusion: There was no evidence that an intensive CN-supported discharge program can prevent hospital readmissions in older patients with CLD.

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