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International Journal of Environmental... Oct 2021Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate... (Review)
Review
Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.
Topics: Aftercare; Humans; Patient Discharge; Patient Readmission; Teach-Back Communication; Telemedicine
PubMed: 34639741
DOI: 10.3390/ijerph181910442 -
Archives of Physical Medicine and... Jul 2021To systematically review and synthesize the evidence on physical activity and sedentary behavior during and after hospitalization.
OBJECTIVES
To systematically review and synthesize the evidence on physical activity and sedentary behavior during and after hospitalization.
DATA SOURCES
Electronic databases and reference lists of relevant articles were searched from 2000 to April 2020.
STUDY SELECTION
Studies which continuously monitored physical activity and/or sedentary behavior in hospitalized adults across 2 settings (ie, without a break in measurement between settings). Monitoring could occur from an acute to a subacute or rehabilitation hospital setting, an acute setting to home, or from a subacute or rehabilitation setting to home.
DATE EXTRACTION
Data extraction and methodological quality assessments were independently performed by 2 reviewers using standardized checklists.
DATA SYNTHESIS
A total of 15 of the 5579 studies identified were included. The studies were composed of heterogenous patient populations. All studies monitored patients with either an accelerometer and/or pedometer and reported a variety of measures, including steps per day, sedentary time, and activity counts. The majority of studies (12 of 15) showed that patients engaged in 1.3 to 5.9 times more physical activity and up to 67% less daily sedentary behavior at home after discharge from acute or subacute settings.
CONCLUSIONS
Patients engaged in more physical activity and less sedentary behavior at home compared to both the acute and subacute hospital settings. This may reflect the natural course of recovery or the effect of setting on activity levels. Enabling early discharge home through the implementation of home-hospitalization models may result in increased patient physical activity and reduced sedentary behavior. Further experimental studies are required investigating the effect of home-based models of care on physical activity and sedentary behavior.
Topics: Exercise; Hospitalization; Humans; Patient Discharge; Sedentary Behavior
PubMed: 33347891
DOI: 10.1016/j.apmr.2020.11.012 -
Injury Feb 2022Trauma accounts for nearly one-tenth of the global disability-adjusted life-years, a large proportion of which is seen in low- and middle-income countries (LMICs).... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Trauma accounts for nearly one-tenth of the global disability-adjusted life-years, a large proportion of which is seen in low- and middle-income countries (LMICs). Trauma can affect employment opportunities, reduce social participation, be influenced by social support, and significantly reduce the quality of life (QOL) among survivors. Research typically focuses on specific trauma sub-groups. This dispersed knowledge results in limited understanding of these outcomes in trauma patients as a whole across different populations and settings. We aimed to assess and provide a systematic overview of current knowledge about return-to-work (RTW), participation, social support, and QOL in trauma patients up to one year after discharge.
METHODS
We undertook a systematic review of the literature published since 2010 on RTW, participation, social support, and QOL in adult trauma populations, up to one year from discharge, utilizing the most commonly used measurement tools from three databases: MEDLINE, EMBASE, and the Cochrane Library. We performed a meta-analysis based on the type of outcome, tool for measurement, and the specific effect measure as well as assessed the methodological quality of the included studies.
RESULTS
A total of 43 articles were included. More than one-third (36%) of patients had not returned to work even a year after discharge. Those who did return to work took more than 3 months to do so. Trauma patients reported receiving moderate social support. There were no studies reporting social participation among trauma patients using the inclusion criteria. The QOL scores of the trauma patients did not reach the population norms or pre-injury levels even a year after discharge. Older adults and females tended to have poorer outcomes. Elderly individuals and females were under-represented in the studies. More than three-quarters of the included studies were from high-income countries (HICs) and had higher methodological quality.
CONCLUSION
RTW and QOL are affected by trauma even a year after discharge and the social support received was moderate, especially among elderly and female patients. Future studies should move towards building more high-quality evidence from LMICs on long-term socioeconomic outcomes including social support, participation and unpaid work.
Topics: Aftercare; Aged; Female; Humans; Income; Patient Discharge; Quality of Life; Return to Work
PubMed: 34706829
DOI: 10.1016/j.injury.2021.10.012 -
Journal of Oncology Pharmacy Practice :... Jul 2023Patients with cancer need care from a multidisciplinary team due to the complexity of the clinical picture and proposed treatment. Hospital discharge is a critical step,... (Review)
Review
INTRODUCTION
Patients with cancer need care from a multidisciplinary team due to the complexity of the clinical picture and proposed treatment. Hospital discharge is a critical step, because pharmacotherapy changes may occur during hospitalization, leading to potential medication-related problems at home.
OBJECTIVE
To identify publications which describe the activities performed by the pharmacist at the hospital discharge of patients with cancer.
METHOD
This is an integrative systematic literature review. A search was carried out in the MEDLINE databases, via Pubmed, Embase, and Virtual Health Library, using the following descriptors: "Patient Discharge", "Pharmacists", "Neoplasms." Studies that reported activities performed by the pharmacist at the hospital discharge of patients with cancer were included.
RESULTS
Five hundred and two studies were identified, of which seven met the eligibility criteria. Most were conducted in the United States (n = 3), and the rest in Belgium, Brazil, Canada, and Italy. Among the services provided by the pharmacist at discharge, medication reconciliation was the most widely described. Other activities such as counseling, education, identification, and resolution of drug-related problems were also carried out.
CONCLUSION
In the scenario of hospital discharge of patients with cancer, the participation of pharmacists is still to be seen as of significance in regards to publications. Despite this, the results suggest that the actions of this professional contribute to patient orientation and the safe use of prescription drugs for use at home.
Topics: Humans; Patient Discharge; Pharmacists; Pharmacy Service, Hospital; Medication Reconciliation; Neoplasms; Hospitals
PubMed: 36895125
DOI: 10.1177/10781552231160678 -
BMC Psychiatry Nov 2016Psychiatric readmissions have been studied at length. However, knowledge about how environmental and health system characteristics affect readmission rates is scarce.... (Review)
Review
BACKGROUND
Psychiatric readmissions have been studied at length. However, knowledge about how environmental and health system characteristics affect readmission rates is scarce. This paper systemically reviews and discusses the impact of health and social systems as well as environmental characteristics for readmission after discharge from inpatient care for patients with a psychiatric diagnosis.
METHODS
Comprehensive literature searches were conducted in the electronic bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. In addition, Google Scholar was utilised. Relevant publications published between January 1990 and June 2014 were included. No restrictions regarding language or publication status were imposed. A qualitative synthesis of the included studies was performed. Variables describing system and environmental characteristics were grouped into three groups: those capturing regulation, financing system and governance; those capturing capacity, organisation and structure; and those capturing environmental variables.
RESULTS
Of the 734 unique articles identified in the original search, 35 were included in the study. There is a limited number of studies on psychiatric readmissions and their association with environmental and health system characteristics. Even though the review reveals an extensive list of characteristics studied, most characteristics appear in a very limited number of articles. The most frequently studied characteristics are related to location (local area, district/region/country). In most cases area differences were found, providing strong indication that the risk of readmission not only relates to patient characteristics but also to system and/or environmental factors that vary between areas. The literature also points in the direction of a negative association of institutional length of stay and community aftercare with readmission for psychiatric patients.
CONCLUSION
This review shows that analyses of system level variables are scarce. Furthermore they differ with respect to purpose, choice of system characteristics and the way these characteristics are measured. The lack of studies looking at the relationship between readmissions and provider payment models is striking. Without the link to provider payment models and other health system characteristics related to regulation, financing system and governance structure it becomes more difficult to draw policy implications from these analyses.
Topics: Follow-Up Studies; Hospitalization; Humans; Length of Stay; Mental Disorders; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Rehabilitation, Vocational
PubMed: 27821155
DOI: 10.1186/s12888-016-1099-8 -
Systematic Reviews Apr 2019The majority of children receiving care in the emergency department (ED) are discharged home, making discharge communication a key component of quality emergency care....
BACKGROUND
The majority of children receiving care in the emergency department (ED) are discharged home, making discharge communication a key component of quality emergency care. Parents must have the knowledge and skills to effectively manage their child's ongoing care at home. Parental fatigue and stress, health literacy, and the fragmented nature of communication in the ED setting may contribute to suboptimal parent comprehension of discharge instructions and inappropriate ED return visits. The aim of this study was to examine how and why discharge communication works in a pediatric ED context and develop recommendations for practice, policy, and research.
METHODS
We systematically reviewed the published and gray literature. We searched electronic databases CINAHL, Medline, and Embase up to July 2017. Policies guiding discharge communication were also sought from pediatric emergency networks in Canada, USA, Australia, and the UK. Eligible studies included children less than 19 years of age with a focus on discharge communication in the ED as the primary objective. Included studies were appraised using relevant Joanna Briggs Institute (JBI) checklists. Textual summaries, content analysis, and conceptual mapping assisted with exploring relationships within and between data. We implemented an integrated knowledge translation approach to strengthen the relevancy of our research questions and assist with summarizing our findings.
RESULTS
A total of 5095 studies were identified in the initial search, with 75 articles included in the final review. Included studies focused on a range of illness presentations and employed a variety of strategies to deliver discharge instructions. Education was the most common intervention and the majority of studies targeted parent knowledge or behavior. Few interventions attempted to change healthcare provider knowledge or behavior. Assessing barriers to implementation, identifying relevant ED contextual factors, and understanding provider and patient attitudes and beliefs about discharge communication were identified as important factors for improving discharge communication practice.
CONCLUSION
Existing literature examining discharge communication in pediatric emergency care varies widely. A theory-based approach to intervention design is needed to improve our understanding regarding discharge communication practice. Strengthening discharge communication in a pediatric emergency context presents a significant opportunity for improving parent comprehension and health outcomes for children.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number: CRD42014007106.
Topics: Child; Communication; Emergency Service, Hospital; Humans; Parents; Patient Discharge
PubMed: 30944038
DOI: 10.1186/s13643-019-0995-7 -
BMJ Open Aug 2017Many studies have assessed the predictors of morbidity/mortality of patients with traumatic brain injury (TBI) in acute care. However, with the increasing rate of... (Review)
Review
INTRODUCTION
Many studies have assessed the predictors of morbidity/mortality of patients with traumatic brain injury (TBI) in acute care. However, with the increasing rate of survival after TBI, more attention has been given to discharge destinations from acute care as an important measure of clinical priorities. This study describes the design of a systematic review compiling and synthesising studies on the prognostic factors of discharge settings from acute care in patients with TBI.
METHODS AND ANALYSIS
This systematic review will be conducted on peer-reviewed studies using seven databases including Medline/Medline in-Process, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PsycINFO, CINAHL and Supplemental PubMed. The reference list of selected articles and Google Scholar will also be reviewed to determine other relevant articles. This study will include all English language observational studies that focus on adult patients with TBI in acute care settings. The quality of articles will be assessed by the Quality in Prognostic Studies tool.
ETHICS AND DISSEMINATION
The results of this review will provide evidence that may guide healthcare providers in making more informed and timely discharge decisions to the next level of care for patient with TBI. Also, this study will provide valuable information to address the gaps in knowledge for future research.
TRIAL REGISTRATION NUMBER
Trial registration number (PROSPERO) is CRD42016033046.
Topics: Brain Injuries, Traumatic; Humans; Patient Discharge; Prognosis; Treatment Outcome
PubMed: 28860230
DOI: 10.1136/bmjopen-2017-016694 -
Emergencias : Revista de La Sociedad... Feb 2020To evaluate the efficacy of intraosseous access versus venous access in out-of-hospital cardiac arrest in terms of return of spontaneous circulation (ROSC) and survival... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate the efficacy of intraosseous access versus venous access in out-of-hospital cardiac arrest in terms of return of spontaneous circulation (ROSC) and survival to hospital discharge with or without favorable neurologic status.
MATERIAL AND METHODS
Systematic review and meta-analysis of articles indexed in MEDLINE (PubMed), Embase, the Web of Science, and the Cochrane Library. Other terms adapted to the language of each index were also used. We included observational studies and clinical trials published from January 1, 1950, to May 31, 2019, if the study population included adult patients in cardiac arrest outside the hospital and in whom an intraosseous or intravenous catheter was inserted. Risk of bias was evaluated with the Cochrane and GRADE (Grading of Recommendations Assessment, Development and Evaluation) tools.
RESULTS
We identified 434 papers to include in the qualitative review and 5 studies for meta-analysis. Intraosseous access was related to a lower rate of ROSC (odds ratio [OR], 0.69; 95% CI, 0.57-0.83; P=.02; I2=65%) and worse survival to discharge (OR, 0.65; 95% CI, 0.51-0.83); P<.01, I2=30%).
CONCLUSION
Intraosseous access in out-of-hospital cardiac arrest is related to poorer outcomes in terms of ROSC and survival at hospital discharge.
Topics: Adult; Catheterization; Humans; Infusions, Intraosseous; Odds Ratio; Out-of-Hospital Cardiac Arrest; Patient Discharge; Return of Spontaneous Circulation
PubMed: 31909913
DOI: No ID Found -
International Journal of Chronic... 2023Pulmonary rehabilitation (PR) effectively improves symptoms and exercise ability in patients with stable chronic obstructive pulmonary disease (COPD). However, the... (Meta-Analysis)
Meta-Analysis
Effects of Early Pulmonary Rehabilitation on Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.
BACKGROUND
Pulmonary rehabilitation (PR) effectively improves symptoms and exercise ability in patients with stable chronic obstructive pulmonary disease (COPD). However, the effectiveness and timing of early PR on hospitalized patients with acute exacerbation of COPD (AECOPD) is still debated.
METHODS
This study conducted a meta-analysis to compare the outcome benefits between early PR and usual care for patient hospitalized due to AECOPD. A systematic search was performed for retrieving randomized control trials (RCTs) from the PubMed, Embase, and Cochrane library until November 2021. RCTs reporting early PR for AECOPD with hospitalization, either during admission or within four weeks of discharge, were enrolled for systematic review and meta-analysis.
RESULTS
Twenty RCTs (1274 participants) were included. Early PR showed significantly improved readmission rate (ten trials, risk ratio 0.68, 95% confidence interval (CI) 0.50-0.92), 6-minute walking distance (6MWD, twelve trials, MD 59.73, 95% CI 36.34-83.12), St George's Respiratory Questionnaire score (eight trials, MD -10.65, 95% CI -14.78 to -6.52), Borg score (eight trials, MD -0.79, 95% CI -1.26 to -0.32), and modified Medical Research Council dyspnea scale (eight trials, MD -0.38, 95% CI -0.5 to -0.25). However, the trend of mortality (six trials, risk ratio 0.72, 95% CI 0.39-1.34) benefit was not significant. The subgroup analysis showed non-significant trends of better effect in early PR during admission than those after discharge for outcomes of 6MWD, quality of life, and dyspnea. However, non-significant trends of less benefits on mortality and readmission rate were found in early PR during the admission.
CONCLUSION
Overall, early PR is beneficial for AECOPD with hospitalization, and there was no significant outcome difference between PR initiated during admission or within 4 weeks of discharge.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Hospitalization; Quality of Life; Dyspnea; Patient Discharge
PubMed: 37215744
DOI: 10.2147/COPD.S397361 -
Pacing and Clinical Electrophysiology :... Nov 2021Due to an increasing need for cardiac implantable electronic device (CIED) placement, the cost of healthcare has been rising including the cost of hospital stay after... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Due to an increasing need for cardiac implantable electronic device (CIED) placement, the cost of healthcare has been rising including the cost of hospital stay after the procedure. We conducted this systematic review and meta-analysis to assess the safety and feasibility of same-day discharge (SDD) after cardiac device implantations.
METHODS
We searched MEDLINE, and Embase databases from inception to March 2021 to identify studies that compared clinical outcomes between SDD group and hospital overnight stay (HO) group after cardiac device implantations. Outcomes included complications after the procedure, mortality, and re-hospitalization. Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI).
RESULTS
Eight studies (one randomized control trial, three prospective cohort and four retrospective cohort studies) with a total of 61,602 patients (4153 in SDD group and 57,449 in HO group) were included. SDD was not associated with more procedure-related complications. The rates of wound problems (0.94% vs 1.84%, pooled OR = 0.86, 95%CI: 0.2-3.68, p = .834), pneumothorax (1.15% vs 0.73%, pooled OR = 1.36, 95%CI: 0.26-7.12, p = .718), hematoma (0.59% vs 2.32%, pooled OR = 0.35, 95%CI:0.01-9.85, p = .534), lead/device dislodgement (4% vs 2.48%, pooled OR = 1.71, 95%CI: 0.64-4.54, p = .281), readmission rate (17.6% vs 17.5%, pooled OR = 0.95, 95%CI: 0.74-1.21, p = .667), and mortality rate (1.66% vs 1.44%, pooled OR = 0.77, 95%CI: 0.58-1.01, p = .059) were similar between in SDD and HO groups respectively.
CONCLUSIONS
Our meta-analysis suggested that SDD after cardiac device implantations might be a safe and feasible alternative to HO without differences in procedure-related complications, readmission rates, or mortality rates.
Topics: Ambulatory Care; Defibrillators, Implantable; Humans; Length of Stay; Patient Discharge; Patient Readmission; Patient Selection
PubMed: 34564864
DOI: 10.1111/pace.14368