The Effect of the Care Transitions Intervention on ED Revisits and Outpatient Clinic Follow-Up among Older Adults Who Live Alone

Introduction: Older adults frequently return to an emergency department (ED) within 30 days of an initial visit. In this study, we examined the effectiveness of an adapted Care Transitions Intervention (CTI) at reducing risk of ED revisits within 30 days for older adults who live alone. We also explored the interaction between receiving help with healthcare needs and receiving the CTI on the risk of 30-day ED revisits. Methods: We conducted a subgroup analysis of community-dwelling older (age≥60 years) ED patients who reported living alone as part of a randomized controlled trial of CTI effectiveness following discharge home from one of three EDs in two states. The primary outcome (ED revisits within 30 days of discharge) and secondary outcomes (ED revisits within 14 days, outpatient follow-up within 7 and 30 days) were obtained from medical record review and patient surveys. Two-sample t-tests and binomial logistic regression were used to analyze main and interaction effects of the CTI and receiving help with healthcare tasks (self-reported) for each outcome. Results: For participants living alone, key characteristics did not significantly differ across randomization groups (278 intervention, 281 control). Overall, 196 (35.2%) reported receiving help with healthcare needs. The CTI had no direct effect on risk of ED revisits or outpatient follow-up at any time point. The interaction of the CTI and receiving help with healthcare needs did not affect risk of ED revisits but did significantly impact likelihood of outpatient clinic follow-up within 7 days ( p=0.01). Of participants who had help with healthcare needs, those who were assigned to the CTI had decreased odds of outpatient clinic follow-up at 7 days (OR: 0.47, 95%CI 0.86–2.18), compared to those not randomized to the CTI condition. Conclusion: For older adults who live alone being discharged from the ED, assignment to the CTI did not decrease ED revisit risk or increase likelihood of outpatient follow-up. Participants assigned to receive the intervention who reported receiving help with health care needs had a decreased likelihood of outpatient clinic follow-up within 7 days. Further research is needed to explore ways to improve the ED-to-home transition in this population.