RED-D intervention reduces unplanned hospital readmissions for individuals with depressive symptoms

Results from a new study at Boston Medical Center show how post-discharge menopause support and depression treatment reduce unplanned hospital readmissions for individuals with depressive symptoms. Published in Annals of Family Medicine, researchers found a 70 and 48 percent reduction in hospital readmission at 30 and 90 days of post-discharge care through a modified version of the Re-Engineered Discharge (RED) Program, a nationally distributed readmission reduction program, among the supporters of the program. The modified version is called RED for Depression (RED-D).

Founded in 2007, Project RED encompasses a suite of strategies aimed at improving the discharge process in ways that promote patient safety and reduce readmissions and emergency room visits. The intervention provides a color-coded, easy-to-read plan that informs patients about medications, upcoming appointments, and a calendar of activities for the next 30 days. However, despite the use of RED, 30-day readmissions and emergency room visits were still 1.5 to 2 times higher in participants with comorbid depressive symptoms. To address this increased risk, researchers modified the original RED program to include new protocols and depression treatments to provide patients with a more successful outcome.

Delivery of the RED-D intervention to hospitalized patients with depressive symptoms has a significant positive impact on readmission rates. This intervention can help overcome barriers to temporary health care for marginalized and disadvantaged populations, such as people living in rural areas and disadvantaged communities, or people with disabilities.”

Suzanne Mitchell, MD, MSc, family physician at Boston Medical Center and associate professor of family medicine at Boston University School of Medicine

Researchers found that each additional RED-D session patients participated in was associated with a decrease in the number of readmissions at 30 and 90 days. Readmission rates within 30 days decreased from 10 percent among those who received RED alone to 3 percent among participants who received three or more sessions of RED-D. Readmission rates within 90 days decreased from 21 percent among those who received RED alone to 11 percent among participants who received six or more sessions of RED-D.

The randomized control study included 709 participants who were categorized as receiving the RED or RED-D intervention. Researchers evaluated the RED protocol in conjunction with the 12-week post-discharge program (RED-D). The 12-week program included telephone brief cognitive behavioral therapy, patient navigation, self-management supportive intervention, and sharing information with a primary physician.

“We conducted the trial to evaluate whether an intervention that combined the original RED protocol with additional post-discharge support would prevent unplanned readmission and ED use in patients with depressive symptoms,” said Brian Jack, MD, a primary care physician at the Boston University of California. Medical Center and a professor of family medicine at Boston University School of Medicine. “These data support screening for depressive symptoms in patients admitted to acute care facilities and provide counseling after discharge. Our data supports accessible telephone delivery of RED-D.”

Researchers note that future research needs to be done in diverse clinical settings to further study the feasibility and acceptance of the RED-D protocol.

This study was supported by the Agency for Health Research and Quality (RO1HS019700) and the Blue Cross Blue Shield Foundation of Massachusetts (MHCA-2269).