BOSTON - Results from a new study at Boston Medical Center show how transition support and post-discharge depression treatment reduce unplanned hospital readmissions for individuals with depressive symptoms. Published in Annals of Family Medicine, researchers discovered a 70 and 48 percent reduction in hospital re-admittance at the 30- and 90-day mark following post-discharge care by an adapted version of the Re-Engineered Discharge (RED) Program, a nationally disseminated readmission reduction program, amongst adherents to the program. The adapted version is named RED for Depression (RED-D).

Project RED was established in 2007 and includes a set of strategies aimed at improving the discharge process in a way that promotes patient safety and reduces readmission rates and emergency department visits. The intervention provides a color-coded, easy to read plan that gives patients information about medications, upcoming appointments, and a calendar of activities for the following 30 days. Despite the use of RED, however, 30-day readmissions and emergency department visits were still 1.5 to 2 times higher among participants with comorbid depressive symptoms. To address this increased risk, researchers adapted the original RED program to include new protocols and depression treatment to set patients up for a more successful outcome.

“Delivery of the RED-D intervention to hospitalized patients with depressive symptoms has an important positive impact on readmission rates,” says Suzanne Mitchell, MD, MSc, a family medicine physician at Boston Medical Center and an associate professor of family medicine at Boston University School of Medicine. “This intervention could help overcome barriers to transitional health care services for marginalized and underserved populations such as those living in rural and underserved communities, or those with disabilities.” 

Researchers found that each additional RED-D session that patients engaged in was associated with a decrease in 30- and 90-day readmissions. Readmissions within 30 days dropped from 10 percent amongst those who received RED alone to 3 percent amongst the participants that received three or more sessions of RED-D. Readmissions within 90 days dropped from 21 percent amongst those who received RED alone to 11 percent amongst the participants that received six or more sessions of RED-D.

The randomized control trial included 709 participants who were categorized as receiving the RED or RED-D intervention. Researchers evaluated the RED protocol combined with the 12-week post-discharge program (RED-D). The 12-week program included telephonic brief cognitive-behavioral therapy, patient navigation, self-management support intervention, and information sharing with a primary physician.

“We conducted the trial to evaluate whether an intervention that combined the original RED protocol with additional support after discharge would avoid unplanned readmission and ED use in patients with depressive symptoms,” says Brian Jack, MD, a family medicine physician at Boston Medical Center and a professor of family medicine at Boston University School of Medicine. “These data support screening for depressive symptoms among patients admitted to acute care facilities and providing post-discharge counseling. Our data support the accessible telephonic delivery of RED-D.”

Researchers note that future research should be done in diverse clinical settings to further study the feasibility and uptake of the RED-D protocol. 

This study was supported by the Agency for Health Research and Quality (RO1HS019700) and the Blue Cross Blue Shield Foundation of Massachusetts (MHCA-2269). 

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