Safe homecoming intervention after hospital discharge: a retrospective cohort study of mortality and readmission among patients 75 years or older in Sweden.

BACKGROUND

After a hospital stay, older patients are at increased risk of health complications that may lead to readmission to hospital or premature death. Globally, numerous interventions have been applied to enhance transitional care for older patients, but the evidence base remains inconclusive. One form of a transitional care intervention is the Swedish primary health care Safe homecoming intervention, a time-limited, interprofessional and tailored home health care intervention designed to prevent avoidable complications and readmissions following hospital discharge. The effects of Safe homecoming have not yet been scientifically evaluated. The present study aimed to assess the association between the interprofessional Safe homecoming intervention and the risk of death or readmission.

METHODS

We conducted a retrospective propensity score-matched cohort study in Örebro County, Sweden, using administrative and medical-record data from 2013 to 2020. The source cohort comprised 38,338 patients aged 75 years or older who had been admitted to hospital for at least one day. We included 128 patients who received the interprofessional Safe homecoming intervention at a single primary health care centre between 1 November 2016 and 31 May 2019 and 512 propensity score-matched controls from across the county receiving standard care.

RESULTS

The mean age was 85.5 years, and 60.9% of patients in both groups were women. At 90 days, the cumulative incidence of first hospital readmission was 20.3% in the intervention group and 33.6% among controls (Gray's test p = 0.005). In the competing-risk analysis, the Fine-Gray subdistribution hazard ratio was 0.57 (95% CI 0.37-0.86; p = 0.008). The corresponding cause-specific Cox model yielded an HR of 0.55 (95% CI 0.36-0.84; p = 0.005). At 365 days, the Fine-Gray estimate was 0.79 (95% CI 0.59-1.05; p = 0.098). Mortality estimates favoured the intervention group numerically but were imprecise, with confidence intervals including the null at all evaluated follow-up times.

CONCLUSION

The Safe Homecoming intervention was associated with a lower risk of first hospital readmission at 90 days, whereas there was no clear evidence of an association with mortality or longer-term readmission. Given the observational design, small intervention sample, potential residual confounding and evaluation of multiple follow-up time points, these findings should be considered exploratory and require confirmation in larger prospective studies.