Homeward Bound, not hospital rebound: how transitional palliative care can reduce readmission

Posted by
  1. Dio Kavalieratos1,2,
  2. Bruce L Rollman2,3,
  3. Robert M Arnold1,2
  1. 1Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3Center for Behavioral Health and Smart Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Dio Kavalieratos, Department of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA; diok{at}pitt.edu

Despite therapeutic advances in the management of heart failure (HF), approximately 25% of hospitalised patients with HF are readmitted within 30 days.1 These costly episodes of care have given rise to numerous policy initiatives, such as the Medicare Hospital Readmissions Reduction Programme which fiscally penalises hospitals with ‘excess’ readmissions.2

Transitional care programmes have emerged as a potential solution to avert HF readmissions by monitoring and supporting patients and caregivers for a limited period of time post-discharge. A recent meta-analysis of these interventions suggests that programmes which incorporate home visits are effective at reducing all-cause readmission and mortality, whereas less-intensive programmes of structured telephone support alone can reduce HF-related readmissions and mortality.3

In their Heart publication, Wong et al report the findings from their pilot trial of a transitional palliative care programme for patients with end-stage HF (TPC-ESHF).4 They demonstrate that patients randomised to their TPC-ESHF intervention experienced significantly fewer hospital readmissions at 12-week follow-up compared with their attention control (relative risk (95% CI) 0.55 (0.35 to 0.88)) along with significant improvements in health-related quality of life (QOL), satisfaction with care and symptom burden.

These results are striking, particularly for a study of its size. As the authors note, a comparative effectiveness trial is in order to confirm their findings and to address key limitations in their pilot. First, their study population vastly differs from similar HF trials, namely regarding social support and the low use of evidence-based therapy for an …

Leave a Reply

Your email address will not be published. Required fields are marked *