A program created by the Camden (N.J.) Coalition of Healthcare Providers to coordinate outpatient care and social services for patients with complex medical and social needs after discharge from the hospital does not significantly reduce readmission rates, according to a randomized, controlled trial reported this week in the New England Journal of Medicine. The study randomly assigned 800 hospitalized patients to the Coalition’s Camden Core Model or usual care after discharge between 2014 and 2017, and found the readmissions rate six months after discharge was about 62% for both groups.
 
“It is possible that approaches to care management that are designed to connect patients with existing resources are insufficient for these complex cases,” the authors said. “The Coalition has continually worked to adapt the model to the needs of its patient population, and both the Coalition and others are exploring models that involve more complete redesigns of care provisions.”
 
Jay Bhatt, D.O., AHA senior vice president and chief medical officer, said, “America’s hospitals and health systems are using a variety of evidence-based strategies that have resulted in real progress in reducing readmissions for all patients. Encouragingly, this study reported readmissions reductions for all participants — a real achievement given the significant complexity and vulnerability of the patient population. At the same time, these results can help prompt a deeper exploration about how to further accelerate progress for the most vulnerable patients, including how to structure interventions and which patient populations benefit the most from the most intensive interventions. While we have made important strides in care delivery, we are continuously looking for new and better ways to engage our public and private sector partners, including local community organizations, to reduce costs and improve care for vulnerable people with complex medical issues.”

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