Investigating the impact of intervention refusal on hospital readmission.

OBJECTIVES: To identify characteristics and readmission risks associated with opting out of a social work-driven transition intervention.

STUDY DESIGN: Secondary data analysis of a randomized controlled pilot study at a large nonprofit urban community hospital.

METHODS: Hospitalized English-speaking, cognitively intact adults 65 years or older with expected discharge back to the community were eligible for enrollment. Additionally, patients met at least 1 of the 3 criteria: 1) 75 years or older, 2) taking 5 or more medications, or 3) had 1 or more prior inpatient stays or emergency department visits in the previous 6 months. The transition intervention consisted of up to 2 in-home visits (the first occurring within 48 hours after discharge) and up to 4 telephone follow-up calls (for a maximum of 6 total contacts) by a transition social worker. This study analyzed participants randomized to the intervention arm on measures including demographics, medical diagnoses, presence of advance directive, and all-cause 30-day hospital readmissions.

RESULTS: Of the 90 patients randomized to the Social Work Intervention Focused on Transitions intervention group, 10% were readmitted within 30 days and nearly one-third refused (ie, opted out of) the home visit component of the intervention. Multivariate analyses revealed that those opting out of the intervention had 3 times greater odds of having a respiratory condition compared with intervention recipients (odds ratio [OR], 3.10; 95% CI, 1.09-8.80; P = .034). Additionally, opting out of the intervention (OR, 6.75; 95% CI, 1.05-43.52; P = .045) and having a diagnosis of cancer (OR, 29.59; 95% CI, 2.01-435.45; P = .014) significantly predicted readmission.

CONCLUSIONS: Findings suggest that some at-risk patients may not be receptive to services and programs aimed at improving care transitions, resulting in a higher risk for readmission.