Background: A small number of patients account for a disproportionate number of hospital readmissions. The Complex High Admission Management Program (CHAMP) is designed to improve care and reduce hospitalizations for frequently readmitted patients. Non-randomized studies of CHAMP found reductions in readmission but may be subject to regression to the mean. We conducted a randomized trial of CHAMP compared with usual care to accurately assess the program’s effect on hospital readmissions.
Methods: The CHAMP team consists of 2.0 FTE social workers, 0.6 FTE physicians, 0.1 FTE program administrator, and support from pharmacy residents, a psychologist, and a pre-existing transitional care clinic. The study had three inclusion criteria: A) 3 or more 30-day inpatient readmissions to Northwestern Memorial Hospital in a 12-month period, B) 2 or more readmissions plus referral from a care team member, or C) 2 readmissions plus 3 observation stays. Patients already followed by a multidisciplinary team (i.e. oncology, transplant) were excluded. Eligible patients were randomized to CHAMP or control (delayed-enrollment, eligible for CHAMP in 18 months). The primary outcome was number of inpatient 30-day readmissions at 180 days after enrollment; secondary outcomes included number of inpatient 30-day readmissions at 30 and 90 days, total hospital admissions, and time to third inpatient 30-day readmission. Results were stratified by presence of sickle cell disease.
Results: We randomized 75 eligible patients to CHAMP and 76 to control. CHAMP and control patients were similar in age, sex, demographics; 7 CHAMP and 6 control patients had sickle cell disease. Both groups had fewer readmissions at 180 days after enrollment compared to 180 days prior to enrollment [baseline CHAMP mean 2.7 (95% CI 2.3-3.0) vs. control 2.7 (95% CI 2.4-3.1), p=0.87]. However, CHAMP-enrolled patients had more inpatient 30-day readmissions at 180 days [CHAMP mean 1.3 (95% CI 0.9-1.8) vs. control 0.8 (95% CI 0.5-1.1), p=0.04]. Readmissions were concentrated among patients with sickle cell disease [CHAMP mean 4.8 (95% CI 2.4-9.5) vs. control 1.7 (95% CI 0.4-6.4), p=0.17]; there were no differences in readmissions among patients without sickle cell disease [CHAMP mean 0.9 (95% CI 0.6-1.2) vs. control 0.7 (95% CI 0.5-1.0), p=0.31]. There were no differences in number of 30-day readmissions at 30 and 90 days, total hospital admissions, or in time to third inpatient readmission between the groups.
Conclusions: In a randomized study, frequently hospitalized patients enrolled in CHAMP experienced reductions in utilization over time, similar to observational studies. However, CHAMP did not reduce readmissions compared to a control group. Though CHAMP may affect other critical aspects of patient care, such as patient-reported outcomes, interventions targeting specific medical or social needs may be more suited to reducing hospitalization.