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A New Multimodal Geriatric Discharge-Planning Intervention to Prevent Emergency Visits and Rehospitalizations of Older Adults: The Optimization of Medication in AGEd Multicenter Randomized Controlled Trial

Authors

  • Sylvie Legrain MD,

    Corresponding author
    1. Unité de Formation et de Recherche de Médecine, Université Paris Diderot, Sorbonne Paris Cité
    2. Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bretonneau;
    • Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bichat;
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  • Florence Tubach MD, PhD,

    1. Unité de Formation et de Recherche de Médecine, Université Paris Diderot, Sorbonne Paris Cité
    2. Department of Epidemiology, Biostatistics, and Clinical Research, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bichat;
    3. INSERM, CIE 801;
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  • Dominique Bonnet-Zamponi MD,

    1. Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bichat;
    2. Unité de Formation et de Recherche de Médecine, Université Paris Diderot, Sorbonne Paris Cité
    3. Department of Epidemiology, Biostatistics, and Clinical Research, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bichat;
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  • Aurélie Lemaire MD,

    1. Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
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  • Jean-Pierre Aquino MD,

    1. Geriatric Unit, Clinique de la Porte Verte, Versailles, France
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  • Elena Paillaud MD,

    1. Department of Geriatrics and Internal Medicine, L'Assistance Publique—Hôpitaux de Paris, Hôpital Albert Chenevier;
    2. Medical School, Université Paris Est, Créteil, France
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  • Elodie Taillandier-Heriche MD,

    1. Department of Geriatrics and Internal Medicine, L'Assistance Publique—Hôpitaux de Paris, Hôpital Albert Chenevier;
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  • Caroline Thomas MD,

    1. Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Saint-Antoine;
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  • Marc Verny MD, PhD,

    1. Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
    2. Université Pierre et Marie Curie (UPMC; Paris 6), Paris, France
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  • Blandine Pasquet MSc,

    1. Department of Epidemiology, Biostatistics, and Clinical Research, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bichat;
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  • Aline Lasserre Moutet,

    1. Patient Education Unit for Chronic Patients, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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  • Déborah Lieberherr MD,

    1. Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bichat;
    2. Geriatric Unit, Assistance Publique‒Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
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  • Sophie Lacaille MD

    1. Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bichat;
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  • Drs. Bonnet-Zamponi and Tubach contributed equally to this work and should be considered as equal second authors.

Address correspondence to Sylvie Legrain, Geriatric Unit, L'Assistance Publique—Hôpitaux de Paris, Hôpital Bretonneau 23, rue Joseph de Maistre, 75885 Paris Cedex 18. E-mail: sylvie.legrain@brt.aphp.fr

Abstract

Objectives

To determine whether a new multimodal comprehensive discharge-planning intervention would reduce emergency rehospitalizations or emergency department (ED) visits for very old inpatients.

Design

Six-month prospective, randomized (Zelen design), parallel-group, open-label trial.

Setting

Six acute geriatric units (AGUs) in Paris and its surroundings.

Participants

Six hundred sixty-five consecutive inpatients aged 70 and older (intervention group (IG) n = 317; control group (CG) n = 348).

Intervention

Intervention-dedicated geriatricians different from those in the study centers implemented the intervention, which targeted three risk factors for preventable readmissions and consisted of three components: comprehensive chronic medication review, education on self-management of disease, and detailed transition-of-care communication with outpatient health professionals.

Measurements

Emergency hospitalization or ED visit 3 and 6 months after discharge, as assessed by telephone calls to the participant, the caregiver, and the general practitioner and confirmed with the hospital administrative database.

Results

Twenty-three percent of IG participants were readmitted to hospital or had an ED visit 3 months after discharge, compared with 30.5% of CG participants (= .03); at 6 months, the proportions were 35.3% and 40.8%, respectively (= .15). Event-free survival was significantly higher in the IG at 3 months (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.53–0.97, = .03) but not at 6 months (HR = 0.81, 95% CI = 0.64–1.04, = .10).

Conclusion

This intervention was effective in reducing rehospitalizations and ED visits for very elderly participants 3 but not 6 months after their discharge from the AGU. Future research should investigate the effect of this intervention of transitional care in a larger population and in usual acute and subacute geriatric care.

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