• Susan N Hastings, Karen M Stechuchak, Cynthia J Coffman, Elizabeth P Mahanna, Morris Weinberger, Courtney H Van Houtven, Kenneth E Schmader, Cristina C Hendrix, Chad Kessler, Jaime M Hughes, Katherine Ramos, G Darryl Wieland, Madeline Weiner, Katina Robinson, and Eugene Oddone.
• Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, HSR&D, Fulton Street, Durham, NC, USA. susan.hastings@va.gov.
• J Gen Intern Med. 2020 Jan 1; 35 (1): 798679-86.

BackgroundLittle research has been done on primary care-based models to improve health care use after an emergency department (ED) visit.ObjectiveTo examine the effectiveness of a primary care-based, nurse telephone support intervention for Veterans treated and released from the ED.DesignRandomized controlled trial with 1:1 assignment to telephone support intervention or usual care arms (ClinicalTrials.gov: NCT01717976).SettingDepartment of Veterans Affairs Health Care System (VAHCS) in Durham, NC.ParticipantsFive hundred thirteen Veterans who were at high risk for repeat ED visits.InterventionThe telephone support intervention consisted of two core calls in the week following an ED visit. Call content focused on improving the ED to primary care transition, enhancing chronic disease management, and educating Veterans and family members about VHA and community services.Main MeasuresThe primary outcome was repeat ED use within 30 days.Key ResultsObserved rates of repeat ED use at 30 days in usual care and intervention groups were 23.1% and 24.9%, respectively (OR = 1.1; 95% CI = 0.7, 1.7; P = 0.6). The intervention group had a higher rate of having at least 1 primary care visit at 30 days (OR = 1.6, 95% CI = 1.1-2.3). At 180 days, the intervention group had a higher rate of usage of a weight management program (OR = 3.5, 95% CI = 1.6-7.5), diabetes/nutrition (OR = 1.8, 95% CI = 1.0-3.0), and home telehealth services (OR = 1.7, 95% CI = 1.0-2.9) compared with usual care.ConclusionsA brief primary care-based nurse telephone support program after an ED visit did not reduce repeat ED visits within 30 days, despite intervention participants' increased engagement with primary care and some chronic disease management services.Trials RegistrationClinicalTrials.gov NCT01717976.

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