Reducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial

• Published in: Annals of family medicine 2022-05, Vol.20 (3), p.246-254
• Main Authors: Mitchell, Suzanne E, Reichert, Matthew, Howard, Jessica Martin, Krizman, Katherine, Bragg, Alexa, Huffaker, Molly, Parker, Kimberly, Cawley, Mary, Roberts, Hannah Webb, Sung, Yena, Brown, Jennifer, Culpepper, Larry, Cabral, Howard J, Jack, Brian W
• Format: Article
• Language: English
• Subjects: Care and treatment; Complications and side effects; Depression, Mental; Diseases; Hospital patients; Original Research; Prognosis; Psychological aspects; Relapse
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.2801

To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support. This is a randomized controlled trial of hospitalized patients with patient health questionnaire-9 score of 10 or more. We delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention including cognitive behavioral therapy, self-management support, and patient navigation. Primary outcomes were hospital readmission and reutilization rates at 30 and 90 days post discharge. We randomized 709 participants (353 RED-D, 356 RED-only). At 90 days, 265 (75%) intervention participants had received at least 1 RED-D session (median 4). At 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission (9% vs 10%, incidence rate ratio [IRR] 0.92 [95% CI, 0.56-1.52]) or reutilization (27% vs 24%, IRR 1.14 [95% CI, 0.85-1.54]). The intention-to-treat analysis also showed no differences at 90 days in readmission (28% vs 21%, IRR 1.30 [95% CI, 0.95-1.78]) or reutilization (70% vs 57%, IRR 1.22 [95% CI, 1.01-1.49]). In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions (3% vs 10%, IRR 0.30 [95% CI, 0.07-0.84]) compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions (11% vs 21%, IRR 0.52 [95% CI, 0.27-0.92]). Intention-to-treat analysis showed no differences between study groups on secondary outcomes. Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.