A. What evidence are you proposing to translate into practice?
Increase percentage of post-hospitalization follow up phone calls in order to decrease 30-day rehospitalization/readmission rates.
Readmission rates are an important hospital quality marker, estimated at 20% overall. Reducing unnecessary readmissions is a target for quality, cost, and patient experience goals.
A1. Justify that this evidence is “ready for translation.”
Though there is a quantity of research on reducing readmissions, efficacy of specific interventions, including post-discharge follow up phone calls, is mixed. Several observational studies suggest post-discharge telephone calls can decrease readmission rates1,2, though two systematic reviews conclude that these interventions work mostly in concert with more comprehensive transitional care programs.3,4 Despite this, consensus guidelines do recommend this intervention as part of an overall strategy to reduce hospital readmissions.
A2. Identify a single, key behavior change target for your translational activity.
Improve percentage of medicine patients discharged to home who receive a follow up phone call within 3-5 days of discharge.
A3. Conduct a “gap analysis” of your target behavior. Look to diverse sources for “best guess” estimates if specific measures are not available.
Estimates of percentage complete post-discharge phone calls are few. Best guess estimates include using percentage of patients who make it to follow up appointment 2 weeks (50%) and using estimates from prior randomized controlled trials involving telephone follow up interventions which reach 80-90% completion of calls.
B. What is the quality (performance) gap?
Hospital staff and clinic staff have not designed workflow processes or designated personnel to carry out the post-hospitalization phone call.
- % calls made
- % appointments made
C. What is the outcome gap?
- 30-day readmission rates (generally 20%, per hospital compare, 16%)
- Mortality rates from preventable re-hospitalization
- Costs of readmission
- Patient experience/satisfaction
D. Is there evidence that changing performance will improve health (clinical outcomes)?
As above, the evidence that changing the percentage of post-discharge follow up calls is mixed. As with most transitional care interventions, positive studies are usually limited to single center studies that test comprehensive package of interventions that include discharge phone calls.
1. Harrison PL, Hara PA, Pope JE, Young MC, Rula EY. The impact of postdischarge telephonic follow-up on hospital readmissions. Population health management. Feb 2011;14(1):27-32.
2. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Disease-a-month : DM. Apr 2002;48(4):239-248.
3. Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database Syst Rev. 2006(4):CD004510.
4. Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. Oct 18 2011;155(8):520-528.