ED-to-Home Intervention More Effective for Patients Who Are Socioeconomically Disadvantaged

BACKGROUND: Studies to reduce hospital-based acute care have not considered whether interventions are more effective in targeted populations. Our objective was to determine the differential effectiveness of an ED-to-Home transitional care intervention on hospital-based acute care based on socioeconomic disadvantage. RESEARCH DESIGN: Randomized clinical trial assessed the impact of an ED-to-Home transitional care intervention on hospital-based acute care [return emergency department (ED) visits or hospitalizations] within 30 and 60 days of the index ED visit at 2 ED tertiary referral centers in 2014-2015. SUBJECTS: Older, chronically ill ED visitors scheduled for ED discharge, hospital observation, or with frequent ED visits. INTERVENTION: Adapted Coleman Care Transitions Intervention. Intervention arm was interacted with measures of socioeconomic disadvantage [nonwhite race, Medicaid eligibility (low income), or neighborhood disadvantage determined by area deprivation index, or any vs. none of these measures] to assess differential intervention effectiveness. OUTCOME MEASURES: Hospital-based acute care after index ED visit determined by Medicare claims. RESULTS: A total of 1101 patients were enrolled. Patients in the Intervention group with "any disadvantage" had 52% lower odds (OR=0.52; P=0.04) of hospital-based acute care within 60 days of index ED visit compared with usual care participants without disadvantage. The Intervention did not reduce hospital-based acute care in participants without disadvantage. CONCLUSIONS: The ED-to-Home Intervention reduced return ED visits and hospitalizations when measures of socioeconomic disadvantage were considered. It did not reduce these visits for those without disadvantage. These measures are visible in real-time and could be used to target the Intervention to patients most likely to benefit.