Abstract
OBJECTIVES: To compare rates of 30-day readmission between hospital units with a Hospital Elder Life Program (HELP) and control units without HELP. DESIGN: Retrospective cohort study. SETTING: The study took place from July 1, 2013, to June 30, 2014, at the University of Pittsburgh Medical Center Shadyside, a 520-bed community teaching hospital that has used HELP since 2002. Eight medical and surgical units with HELP were compared with 10 medical and surgical units without HELP. PARTICIPANTS: During the study period, HELP units, had 4,794 patients aged 70 and older, and usual care units had 2,834. INTERVENTION: HELP is a multifactorial, multidisciplinary program that provides targeted interventions for delirium risk factors in at-risk individuals in collaboration with bedside staff. MEASUREMENTS: Mixed-effects Poisson regression models were used to estimate the adjusted incident risk ratio for 30-day readmission between HELP and usual care units for the overall cohort and for the subgroup of individuals discharged home, with or without services. RESULTS: Patients on HELP units were more likely than those in usual care units to be older, female, and black and had an unadjusted readmission rate of 16.9%, versus 18.9% for patients on control units. The adjusted risk of readmission was 0.83 (95% confidence interval (CI) = 0.73-0.94, P = .003) for HELP unit patients overall and 0.74 (95% CI = 0.63-0.87, P < .001) for HELP unit patients discharged to home with or without services. CONCLUSION: The HELP program is associated with lower risk of 30-day hospital readmission overall and for the subgroup of individuals discharged to home. Prospective studies are needed to confirm these observations.