Helping Seniors Plan for Posthospital Discharge Needs Before a Hospitalization Occurs: Results from the Randomized Control Trial of PlanYourLifespan.org

Journal of Hospital Medicine 12(11). 2017 November;911-917 | 10.12788/jhm.2798

October 23, 2017|Journal of Hospital Medicine

Lee A. Lindquist, MD, MPH, MBA;Vanessa Ramirez-Zohfeld, MPH;Priya D. Sunkara, MA;Chris Forcucci, RN, BSN;Dianne S. Campbell, BS;Phyllis Mitzen, MA;Jody D. Ciolino, PhD;Gayle Kricke, MSW;Anne Seltzer, LSW;Ana V. Ramirez, BA;Kenzie A. Cameron, PhD, MPH

BACKGROUND: Hospitalized seniors are frequently too sick to make informed decisions about their postdischarge care. Subsequently, loved ones often make support choices (eg, skilled nursing facility placement, caregivers) at discharge. We sought to advance the timeline for postacute care decisions to before a hospitalization occurs.

OBJECTIVE: Investigate the effect of PlanYourLifespan.org (PYL) on knowledge of posthospital discharge options.

DESIGN: Multisite randomized controlled trial.

SETTING/PATIENTS: Nonhospitalized adults, aged ≥65 years, living in urban, suburban, and rural areas of Texas, Illinois, and Indiana.

INTERVENTION: PYL is a national, publicly available tool that provides education on posthospital therapy choices and local home-based resources.

MEASUREMENTS: Participants completed an in-person baseline survey, followed by exposure to intervention or attention control (AC) websites, then 1-month and 3-month telephone surveys. The primary knowledge outcome was measured with 6 items (possible 0-6 points) pertaining to hospital discharge needs.

RESULTS: Among 385 participants randomized, mean age was 71.9 years (standard deviation 5.6) and 79.5% of participants were female. At 1 month, the intervention group had a 0.6 point change (standard deviation = 1.6) versus the AC group who had a −0.1 point change in knowledge score. Linear mixed modeling results suggest sex, health literacy level, level of education, income, and history of high blood pressure/kidney disease were significant predictors of knowledge over time. Controlling for these variables, treatment effect remained significant (P < 0.0001).

CONCLUSION: Seniors who used PYL demonstrated an increased understanding of posthospitalization and home services compared to the control group.

TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02256072.

Acknowledgments

This work was supported through a Patient-Centered Outcomes Research Institute Award (IH-12-11-4259). Dr. Lindquist and Dr. Ciolino had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Research reported in this publication was also supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR000150.

Disclaimer

All statements in this manuscript, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its Board of Governors or Methodology Committee, or the National Institutes of Health.

Disclosure: The authors have nothing to report.