In the U.S., 5% of the population account for 50% of expenditures. Many of these so-called “superutilizers” have multiple comorbidities; some of these patients face economic challenges, while others may contend with mental illness. One approach to attempt to improve quality and reduce cost is to provide these high-cost patients with supplemental services. One question is, does it work?
According to a recent paper in the New England Journal of Medicine by Finkelstein et al. (2020), the answer is ‘no’.
We randomly assigned 800 hospitalized patients with medically and socially complex conditions, all with at least one additional hospitalization in the preceding 6 months, to the Coalition’s care-transition program or to usual care. The primary outcome was hospital readmission within 180 days after discharge.
The 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% confidence interval, −5.97 to 7.61). In contrast, a comparison of the intervention-group admissions during the 6 months before and after enrollment misleadingly suggested a 38-percentage-point decline in admissions related to the intervention because the comparison did not account for the similar decline in the control group.