Outcomes during the index hospitalisation and in first 30 days after discharge
| UAH (intervention site) | Edmonton teaching hospitals (intra-region controls) | Calgary teaching hospitals (extra-region controls) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| PRE (n=706) | POST (n=1190) | Change (95% CI) | PRE (n=1960) | POST (n=2590) | Change (95% CI) | PRE (n=1856) | POST (n=2239) | Change (95% CI) | |
| Efficacy Outcomes: | |||||||||
| Adjusted acute LOS, days (95% CI) | 7.04 (6.65 to 7.43) | 6.00 (5.70 to 6.30) | ARD=1.04 (0.60 to 1.49) decrease | 9.30 (9.10 to 9.50) | 8.67 (8.49 to 8.86) | 0.63 (0.36 to 0.90) decrease | 7.17 (6.97 to 7.38) | 6.46 (6.27 to 6.65) | 0.71 (0.43 to 0.99) decrease |
| Acute LOS in those with any of the top five GIM diagnoses in Alberta, days (95% CI) | 6.76 (5.97 to 7.54) | 5.48 (4.93 to 6.03) | ARD=1.28 (0.34 to 2.21) decrease | 8.87 (8.38 to 9.35) | 8.32 (7.87 to 8.77) | ARD=0.55 (-0.12 to 1.21) decrease | 7.53 (6.91 to 8.14) | 7.67 (7.08 to 8.25) | ARD=-0.14 (-0.98 to 0.70) increase |
| Observed LOS/expected LOS (95% CI) | 1.11 (1.02 to 1.20) | 0.80 (0.75 to 0.83) | ARD=0.31 (0.23 to 0.40) | 1.43 (1.39 to 1.49) | 1.27 (1.24 to 1.31) | ARD=0.16 (0.10,0.27) | 1.18 (1.14 to 1.22) | 1.10 (1.06 to 1.13) | ARD=0.08 (0.03 to 0.13) |
| Safety Outcomes: | |||||||||
| Death during index hospitalisation or death/readmission in 30 days after discharge (%)* | 126 (18.39) | 136 (17.82) | aOR=1.02 (0.80 to 1.31) | 375 (20.02) | 275 (17.81) | aOR=1.04 (0.89 to 1.22) | 261 (14.48) | 230 (15.89) | aOR=1.21 (1.01 to 1.45) |
| Death during index hospitalisation (%) | 33 (4.67) | 52 (4.37) | aOR=0.93 (0.60 to 1.46) | 144 (7.35) | 155 (5.98) | aOR=0.80 (0.64 to 1.02) | 88 (4.74) | 87 (3.90) | aOR=0.81 (0.60 to 1.10) |
| 30 -day readmission for any cause† (%) | 84 (12.48) | 148 (13.01) | aOR=1.08 (0.81 to 1.44) | 196 (10.79) | 295 (12.11) | aOR=1.20 (0.99 to 1.46) | 149 (8.43) | 241 (11.20) | aOR=1.42 (1.14 to 1.77) |
| Death in 30 days after discharge (%)* | 20 (3.06) | 25 (3.39) | aOR=1.13 (0.62 to 2.06) | 60 (3.47) | 49 (3.34) | aOR=1.15 (0.77 to 1.71) | 44 (2.56) | 41 (2.93) | aOR=1.22 (0.79 to 1.90) |
| Discharged back to same level of care as pre-admission† | 605 (89.90) | 1048 (92.09) | aOR=1.13 (0.84 to 1.52) | 1643 (90.47) | 2211 (90.80) | aOR=1.03 (0.87 to 1.23) | 1707 (96.55) | 2076 (96.47) | aOR=1.07 (0.84 to 1.35) |
| Outpatient physician visit within 30 days of discharge | 484 (68.6) | 783 (65.8) | p=0.22 | 1345 (68.6) | 1747 (67.5) | p=0.40 | 1322 (71.2) | 1573 (70.3) | p=0.50 |
| Mean number of outpatient physician visits in the first 30 days after discharge (SD) | 2.5 (3.4) | 2.1 (2.9) | p=0.01 | 2.3 (3.1) | 2.1 (2.7) | p=0.06 | 2.0 (2.2) | 2.1 (2.5) | p=0.30 |
*Mortality data in the first 30 days after discharge are not available for those discharged after 31 December 2011 (23% of patients) and thus denominators for these proportions are not the same as the column heading denominators.
†Denominator excludes those patients who died during index hospitalisation.
ARD, absolute risk difference (positive value denotes shorter LOS in post-time frames vs pre-time frames); aOR, adjusted OR (30 -day readmissions/deaths/or ED visits adjusted for LACE scores at the time of discharge from index hospitalisation; in-hospital mortality adjusted for demographics and Charlson scores); GIM, General Internal Medicine; LOS, length of stay; UAH, University of Alberta Hospital.