The Particulars: Previous research has indicated that home visits after discharge can help prevent hospital readmission, improve patient satisfaction, and improve understanding and compliance. However, these home visits are resource intensive. Coupling home visits to a readmission prediction tool may allow for targeted interventions for high-risk patients.

Data Breakdown: For a study, patients deemed at moderate or high risk for readmission (based on risk scores) were randomized to receive a home visit or routine post-hospitalization care. Patients who received home visits were 18% less likely to be readmitted and 25% less likely to use the ED when compared with those who received standard care. They were also 58% less likely to use the hospital for any reason after their initial hospital visit. Patients in the home visit group who were readmitted had a shorter average stay in the hospital when compared with the standard care group (2.8 days vs 6.7 days).

Take Home Pearls: Coupling a readmission risk tool with post-hospitalization interventions appears to enable allocation of resources for patients who can benefit most from intensive follow-up care. This targeted approach appears to reduce readmissions, decrease length of stay when readmissions occur, and decrease ED use.