The results of a new study at Boston Medical Center show how transition support and post-discharge depression reduce unplanned hospital readmissions for people with depressive symptoms. Published in the Annals of Family Medicine, researchers found a 70- to 48-percent reduction in hospital readmission 30 to 90 days after post-discharge care through an adapted version of the Re-Engineered program. Discharge (RED), a program to reduce national readmission, among program members. The adapted version is called RED for Depression (RED-D).
The RED project was established in 2007 and includes a set of strategies aimed at improving the discharge process in a way that promotes patient safety and reduces readmission rates and emergency room visits. The intervention provides an easy-to-read, color-coded plan that provides patients with information about medications, upcoming appointments, and a schedule of activities for the next 30 days. Despite the use of RED, however, 30-day readmissions and emergency department visits were still 1.5 to 2 times higher among participants with comorbid depressive symptoms. To address this increased risk, the researchers adapted the original RED program to include new protocols and treatment of depression to prepare patients for a more successful outcome.
Delivery of RED-D intervention to hospitalized patients with depressive symptoms has a significant positive impact on readmission rates. This intervention could help overcome barriers to transitional health services for marginalized and neglected populations, such as those living in rural and neglected communities or people with disabilities. “
Suzanne Mitchell, MD, MSc, Family Medicine Physician at Boston Medical Center and Associate Professor of Family Medicine at Boston University School of Medicine
The researchers found that each additional RED-D session in which patients participated was associated with a 30- to 90-day decrease in readmissions. Readmissions in 30 days dropped from 10% among those who received only RED to 3% among participants who received three or more RED-D sessions. Readmissions in 90 days dropped from 21% among those who received only RED to 11% among participants who received six or more RED-D sessions.
The randomized controlled trial included 709 participants who were classified as recipients of the RED or RED-D intervention. The researchers evaluated the RED protocol combined with the 12-week post-discharge program (RED-D). The 12-week program included brief telephone cognitive-behavioral therapy, patient navigation, self-management support intervention, and information exchange with a primary care physician.
“We conducted the trial to assess whether an intervention that combined the original RED protocol with additional post-discharge support would prevent unplanned readmission and the use of ED in patients with depressive symptoms,” says Brian Jack, MD , family physician at Boston Medical Center and professor of family medicine at Boston University School of Medicine. “These data support the detection of depressive symptoms among patients admitted to acute care centers and provide post-discharge counseling. Our data support the accessible telephone delivery of RED-D.”
Researchers point out that future research should be done in various clinical settings to further study the feasibility and adoption of the RED-D protocol.
This study was supported by the Agency for Health Research and Quality (RO1HS019700) and the Blue Cross Blue Shield Foundation of Massachusetts (MHCA-2269).
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Magazine reference:
Mitchell, SE, et al. (2022) Reducing readmission of hospitalized patients with depressive symptoms: a randomized trial. The Annals of Family Medicine. doi.org/10.1370/afm.2801.