Results Summary

What was the research about?

Before patients leave the emergency room, or ER, hospital staff give instructions on how to care for their illness or injury at home. These instructions include getting follow-up care from their regular doctors. For older adults with long-term health issues, follow-up care is important so patients don’t need to return to the ER.

In this study, the research team tested the use of coaches for patients with Medicare insurance who had recently gone home after a visit to the ER. Coaches were from two Area Agencies on Aging, which offer programs and services that help older adults live on their own. Coaches helped patients

  • Schedule follow-up doctor appointments
  • Learn to identify and respond to signs of their health getting worse
  • Review concerns and instructions for taking medicines
  • Talk about care goals with their doctors
  • Arrange for services such as meal delivery and rides to doctor visits

The research team compared patients who worked with these coaches with patients who received usual care from the ER. The team looked at quality of life, the number of times patients had to return to the ER or hospital for care, and the number of times patients went to their regular doctors after their ER visits.

What were the results?

Patients who worked with coaches and those who didn’t had similar

  • Ratings of quality of life
  • Numbers of times they had to return to the ER or hospital
  • Numbers of visits with their regular doctors

Compared with patients who didn’t work with a coach, patients who worked with a coach were less likely to have a hospital stay if they did return to the ER.

Who was in the study?

The study included 1,322 patients getting care from two ERs in Florida. Of these, 48 percent were black, 48 percent were white, and 4 percent were other races. The average age was 72. All patients in the study had Medicare insurance. Most patients had more than one long-term health issue.

What did the research team do?

The research team assigned patients by chance to receive either 30 days of support from a health coach or the usual care patients get when leaving the ER. The health coaches met with patients once in person 24 to 72 hours after patients went home from the ER and up to three times by phone as needed during the rest of the study.

Patients who got usual care received standard instructions when going home from the ER. These instructions included how to care for their illness or injury at home and the importance of scheduling a visit with their regular doctors.

Patients, caregivers, staff from the Area Agency on Aging, doctors, and hospital managers helped the team design the study and interpret results.

What were the limits of the study?

Of the patients who received coaching, only 60 percent met with a coach during the study. Results may have been different if more patients had worked with the coaches after going home from the ER.

How can people use the results?

Hospitals can use these results when considering how to help patients after they go home from the ER.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers expressed concern about the overinterpretation of findings based on a large number of comparisons. Since statistical comparisons were not adjusted for multiple-hypothesis testing, the researchers revised the text to emphasize that outcomes based on multiple comparisons should be interpreted with caution. They also emphasized against overinterpreting marginally significant findings.
  • Given that the tested intervention did not seem to be effective, reviewers asked for insights on why the intervention did not work as hoped. The researchers added comments from patient participants and providers to their report. The researchers also noted that the increase in self-reported patient anxiety associated with the coaching intervention was not a surprise to patient stakeholders. The researchers noted that extra attention may have sensitized patients to their health condition and motivated them to use more healthcare services.

Conflict of Interest Disclosures

Project Information

Donna Lynne Carden, MD
University of Florida
$1,968,011
10.25302/07.2020.IHS.130601451
An Emergency Department-to-Home Intervention to Improve Quality of Life and Reduce Hospital Use

Key Dates

December 2013
December 2018
2013
2018

Study Registration Information

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Last updated: January 20, 2023