Abstract
BACKGROUND: Transitions from hospital to home are risky for older people. The role of patient involvement in supporting safe transitions is unclear.
OBJECTIVE: To assess the clinical effectiveness of an intervention to improve the safety and experience of care transitions for older people.
TRIAL DESIGN: Cluster randomised controlled trial.
PARTICIPANTS: Eleven National Health Service acute hospital trusts and 42 wards (clusters) routinely providing care for older people (aged 75 years and older) planning to transition back home.
INTERVENTION: Patient involvement ward-level intervention-Your Care Needs You (YCNY).
OUTCOMES: Unplanned hospital readmission rates within 30 days of discharge (primary outcome). Secondary outcomes included readmissions at 60 and 90 days post-discharge, experience of transitions and safety events.
RANDOMISATION: Ward as the unit of randomisation from varying medical specialities randomised to YCNY or care-as-usual on a 1:1 basis.
BLINDING: Ward staff, research nurses and researchers were unblinded. Patients were unaware of treatment allocation. Statisticians were blinded to the primary outcome data until statistical analysis plan sign-off.
RESULTS: Using a mixed effects logistic regression we saw no significant difference in unplanned 30-day readmission rates (OR 0.93; 95% CI, 0.78 to 1.10; P = .372) between intervention (17%) and control (19%). At all timepoints, rates were lower in the intervention group. The total number of readmissions was lower in the intervention group (all timepoints) reaching statistical significance across 90-days with 13% fewer readmissions (IRR: 0.87; 95% CI 0.76 to 0.99) than the control. At 30-days only, intervention group patients reported better experiences of transitions and significantly fewer safety events. Serious adverse events were similarly observed in both groups [YCNY: 26 (52.0%), Care-as-usual: 24 (48.0%)]. None related to treatment.
CONCLUSIONS: YCNY did not significantly impact on unplanned hospital readmissions at 30 days but in some secondary outcomes we did find evidence of clinical benefit.
Original language | English |
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Article number | afaf142 |
Number of pages | 11 |
Journal | Age and Ageing |
Volume | 54 |
Issue number | 5 |
DOIs | |
Publication status | Published - 30 May 2025 |
Bibliographical note
© The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society.Keywords
- Humans
- Aged
- Patient Readmission
- Male
- Female
- Patient Discharge
- Aged, 80 and over
- Time Factors
- Patient Safety
- Patient Participation
- Logistic Models
- Age Factors
- State Medicine
- Transitional Care
- Risk Factors
- Home Care Services
- Continuity of Patient Care
- Patient Transfer