‘Patient navigator’ intervention reduces readmissions among older but not younger high-risk safety-net patients

Older patients who were cared for at safety-net hospitals and were at high risk for readmission had lower 30-day readmission rates if they received coaching and assistance from community health workers acting as patient navigators, but the same benefits were not seen among younger patients, a new study found.

Researchers performed a randomized, controlled trial in an academic public safety-net system with 2 hospitals to determine whether a patient navigator intervention would improve readmission rates among those at high risk. General inpatients were considered at high risk for readmission if they had 1 or more of the following risk factors: age older than 60 years, in-network inpatient admission in the past 6 months, a length of stay of at least 3 days, or an admission diagnosis of heart failure or chronic obstructive pulmonary disease.

Those assigned to the patient navigator group received coaching and assistance via hospital visits and weekly telephone calls up to 30 days after discharge that addressed discharge preparation, medication and symptom management, scheduling of follow-up appointments, and communication with primary care. The study's main outcome measures were in-network 30-day hospital readmissions, while secondary outcomes included outpatient follow-up rates. Study results were published online Jan. 24 by the Journal of General Internal Medicine.

A total of 1,937 patients were randomly assigned, 747 to the patient navigator group and 1,190 to the control group. Of these, 585 in the patient navigator group and 925 in the control group were included in the analytic sample. The researchers analyzed outcomes for the entire sample and by age; 425 patients in the intervention group and 584 controls were older than age 60, and 160 patients in the intervention group and 341 patients in the control group were age 60 or younger.

Thirty-day readmission rates did not differ overall between the intervention and control groups. However, a statistically significant difference was seen by age. Patients in the intervention group who were older than age 60 had an adjusted absolute decrease of 4.1% (95% CI, −8.0% to −0.2%) in readmission rates and increased rates of 30-day outpatient follow-up. Patients in the intervention group who were 60 years of age or younger, meanwhile, had an adjusted absolute increase in readmission rates of 11.8% (95% CI, 4.4% to 19.0%) and no change in rates of 30-day outpatient follow-up.

The authors noted that their data covered only in-network readmissions, that discharge coordinators were not blinded to the study group, and that their results may not be generalizable to all settings, among other limitations. However, they concluded that the patient navigator intervention evaluated in their study was associated with reduced readmission rates in older patients but higher rates in younger patients. The study results raise questions about younger patients covered under public insurance, the authors said.

“Did their readmissions address unmet medical needs? Could these readmissions have been prevented with more intensive community-based care? Were our results shaped by previous excluded populations, such as non-English speakers, those leaving [against medical advice], or the homeless?” the authors wrote. “Future studies that address these questions may help to optimize transitional care of vulnerable patients across all age groups.”