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The American Journal of Managed Care December 2017
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Investigating the Impact of Intervention Refusal on Hospital Readmission
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Investigating the Impact of Intervention Refusal on Hospital Readmission

Alexis Coulourides Kogan, PhD; Eileen Koons, MSW, ACSW; and Susan Enguidanos, PhD
Findings suggest that some at-risk patients may not be receptive to in-home transition interventions and that opting out may be associated with higher odds of hospital readmission.
Findings from this study provide insight into the characteristics and risk factors associated with opting out of a care transition intervention and suggest that some at-risk patients may not be receptive to in-home transition interventions. Additionally, opting out of a transition intervention may be associated with higher odds of hospital readmission. Current policies have charged hospitals with the task of reducing 30-day readmission rates; however, these results suggest that it may not be reasonable to place this burden solely on hospitals. Hospital readmissions are a costly phenomenon. Given the current ACA provisions, being able to identify patients who are resistant to interventions and likely to opt out could present a considerable benefit and better inform resource allocation, including CMS funds, potential grants, and hospital resources. More research is needed to confirm these findings and better understand patient characteristics associated with intervention opt-out among at-risk older adults. 


Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number 5 R21 AG034557-02 ( registry number NCT02232126) and partially by award number K99AG052647-02. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Additionally, the authors would like to thank Huntington Senior Care Network and Huntington Memorial Hospital for partnering with them to conduct this work, and each of the study participants who generously gave their time.

Author Affiliations: Department of Family Medicine and Geriatrics, Keck School of Medicine of USC, University of Southern California (ACK), Alhambra, CA; Huntington Memorial Hospital, Senior Care Network (EK), Pasadena, CA; Leonard Davis School of Gerontology, University of Southern California (SE), Los Angeles, CA.

Source of Funding: This study is funded by National Institutes of Health grant number 5 R21 AG034557-02 and partially by grant number K99AG052647-02.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. 

Authorship Information: Concept and design (SE); acquisition of data (ACK); analysis and interpretation of data (ACK, SE); drafting of the manuscript (ACK); critical revision of the manuscript for important intellectual content (ACK, SE); statistical analysis (ACK); provision of patients or study materials (EK, SE); obtaining funding (SE); administrative, technical, or logistic support (EK, SE); and supervision (EK, SE). 

Address Correspondence to: Alexis Coulourides Kogan, PhD, Keck School of Medicine of USC, University of Southern California, 1000 S Fremont Ave, Bldg A-6, 4th Fl, Ste 6420, Alhambra, CA 91803. E-mail:
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