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Implementation of discharge support programs to prevent hospital readmissions has yielded mixed results. Recent meta-analyses of such programs have suggested that multicomponent interventions at the healthcare systems level are required to influence care outcomes (NEJM JW Hosp Med Sep 17 2012). Individual components that lead to better outcomes have yet to be elucidated.
Researchers randomized 700 older, low-income, ethnically diverse patients (mean age, 66) at a single safety net hospital to usual care or to a nurse-led, in-hospital, discharge support intervention. Usual-care patients received registered nurse (RN) reviews of discharge instructions and, if indicated, pharmacy or social-worker consultations. Intervention patients received us…