BACKGROUND Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. TRIAL DESIGN AND METHODS This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics. RESULTS Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization (p = 0.003) and ED presentations (p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations (p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles (p = 0.019), the participation observed in HOME patients with no support was not significantly improved. CONCLUSIONS Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home. TRIAL REGISTRATION The trial was registered before commencement (ACTRN12611000615987).

中文翻译：

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支持有风险的老年人从医院过渡到家庭：谁从以证据为基础的以患者为中心的出院计划干预中受益？随机试验的事后分析。

背景技术老年患者的亚组在出院后以及计划外的医院再入院和急诊科（ED）演示后难以进行日常生活（ADL）活动。我们在以下结果上检查了这些“处于危险中”的老年患者亚组是否比基于证据的出院计划干预受益更多，其原因包括：（1）ADL的独立性，（2）参与生活角色，（3）计划外的住院治疗，以及（4）ED演示。试验设计和方法该研究使用了一项随机对照试验的数据，该试验涉及从澳大利亚5个地点招募的400例患有急性和医学疾病的住院老年患者。参与者可以接受HOME，这是由职业治疗师领导的以患者为中心的出院计划干预；或有组织的院内咨询。HOME使用协作方法来设定目标，包括出院前和出院后的家访以及电话随访。记录与不良后果较高风险相关的特征，并创建高风险亚组（轻度认知障碍，行走困难，合并症，独居和没有家人支持）。使用经过验证的问卷评估了ADL的独立性和参与生活角色的情况。从医疗档案中提取了计划外的住院治疗和ED演示的数量。根据患者的特征，进行了线性回归模型以检测在3个月时对干预措施的响应变化。结果分析显示，对于3个月内计划外的住院治疗（p = 0.003）和ED表现（p = 0.021），认知状态干预对干预具有显着的交互作用。在轻度认知障碍的高危亚组中，HOME干预显着减少了计划外的住院治疗（p = 0.027），但在ED访视中效果并未达到显着水平。虽然HOME的效果因家庭提供的参与生活角色的支持而异（p = 0.019），但在没有支持的HOME患者中观察到的参与没有显着改善。结论研究结果表明，患有轻度认知障碍的住院老年人可从HOME干预中受益，该干预包括在环境中进行准备和出院后支持，以减少计划外的住院治疗。在职业治疗师主导的干预下，此高危亚组的出院结果改善，可在患者从医院过渡到家中时提供最佳护理。试验注册该试验在开始之前已注册（ACTRN12611000615987）。