-
European Journal of Cardiovascular... Jan 2021Because of the importance of a dyadic approach, it is necessary to conduct a systematic review to identify which dyadic intervention could be implemented for stroke... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Because of the importance of a dyadic approach, it is necessary to conduct a systematic review to identify which dyadic intervention could be implemented for stroke survivor-caregiver dyads after discharge from the rehabilitation hospital to improve outcomes.
AIMS
The aims were to systematically review the evidence to identify which dyadic interventions have been implemented in stroke survivor-caregiver dyads to improve stroke survivor-caregiver dyads' outcomes and to analyse, through a meta-analysis, which intervention was found to be the most effective.
METHODS
A systematic review and meta-analysis were conducted using the following electronic databases: PubMed, CINAHL and PsycInfo. Randomized controlled trials (RCTs) and quasi-RCT studies published within the last 10 years were included. Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Pooled effects were analysed between the experimental and control groups for each outcome.
RESULTS
Sixteen studies involving 2997 stroke survivors (male gender=58%) and 2187 caregivers (male gender=25%) were included in this review. In 16 studies, which were subdivided into three quasi-RCTs and 13 RCTs, the application of dyadic interventions for stroke survivors and caregivers was systematically reviewed, but only a few of these identified a significant improvement in the stroke survivors' and caregivers' outcomes of its intervention group. Dyadic interventions showed a significant effect on stroke survivors' physical functioning (p=0.05), memory (p<0.01) and quality of life (p=0.01) and on caregivers' depression (p=0.05).
CONCLUSIONS
This study provides moderate support for the use of a dyadic intervention to improve stroke survivors' physical functioning, memory and quality of life and caregiver depression.
Topics: Caregivers; Depression; Humans; Male; Patient Discharge; Quality of Life; Stroke; Stroke Rehabilitation; Survivors
PubMed: 33570593
DOI: 10.1177/1474515120926069 -
Current Problems in Cardiology Oct 2022With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be... (Meta-Analysis)
Meta-Analysis Review
With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be suboptimal for surgery, there is a need to explore the possibility of next day discharge (NDD) and its potential outcomes. The aim of our study is to compare outcomes and complications following NDD vs the standard early discharge (ED) (less than 3 days). A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Studies comparing same-day or next-day discharge vs discharge within the next three days were included in our analysis. 6 studies with 2,672 patients were identified. The risk of bleeding and vascular complications was significantly lower in patients with NDD compared to ED (OR 0.10, P < 0.00001 and OR 0.22, P = 0.002 respectively). The incidence of permanent pacemaker (PPM) implants was significantly lower in patients who had NDD compared to ED (OR 0.21, P = 0.0005). The incidence of 30 day mortality, stroke, AKI and readmission rates was not different between the two groups. NDD after TAVR allows for reduction in hospital stay and can mitigate hospital costs without an increased risk of complications. Our analysis shows that complication rate is comparable to ED, NDD is a reasonable option for certain patients with severe aortic stenosis who undergo TAVR. Further studies are needed to elucidate whether higher risk patients who would benefit from an extended inpatient monitoring post TAVR.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Humans; Patient Discharge; Risk Factors; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34571105
DOI: 10.1016/j.cpcardiol.2021.100998 -
BMJ Quality & Safety Feb 2021Harm due to medications is common during the transition from hospital to home. Approaches that seek to prevent harm often involve isolated medication-related... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Harm due to medications is common during the transition from hospital to home. Approaches that seek to prevent harm often involve isolated medication-related interventions and show conflicting results. However, until now, no review has focused on the effect of intervention components delivered both in hospital and following discharge from hospital to home.
OBJECTIVE
To examine effects of medication-related interventions on hospital readmissions, medication-related problems (MRPs), medication adherence and mortality.
METHODS
For this systematic review and meta-analysis, we searched the PubMed, Embase, CINAHL and CENTRAL databases without language restrictions. Citations of included articles were checked through Web of Science and Scopus from inception to 20 June 2019. We included prospective studies that examined effects of medication-related interventions delivered both in hospital and following discharge from hospital to home compared with usual care. Three authors independently extracted data and assessed study quality in pairs.
RESULTS
Fourteen original studies were included, comprising 8182 patients. Interventions consisted mainly of patient education and medication reconciliation in the hospital, and patient education following discharge. Nine studies were included in the meta-analysis; compared with usual care (n=3376 patients), medication-related interventions (n=1820 patients) reduced hospital readmissions by 3.8 percentage points within 30 days of discharge (number needed to treat=27, risk ratio (RR) 0.79 (95% CI 0.65 to 0.96)). Meta-regression analysis suggested that readmission rates were reduced by 17% per additional intervention component (RR 0.83 (95% Cl 0.75 to 0.91)). Medication adherence and MRPs may be improved. Effects on mortality were unclear.
CONCLUSIONS
Studied medication-related interventions reduce all-cause hospital readmissions within 30 days. The treatment effect appears to increase with higher intervention intensities. More evidence is needed for recommendations on adherence, mortality and MRPs.
Topics: Hospitals; Humans; Medication Reconciliation; Patient Discharge; Patient Readmission; Prospective Studies
PubMed: 32434936
DOI: 10.1136/bmjqs-2020-010927 -
BMJ Open Dec 2016The transition from hospital to home represents a key step in the management of patients and several problems related to this transition may arise, with potential... (Review)
Review
OBJECTIVE
The transition from hospital to home represents a key step in the management of patients and several problems related to this transition may arise, with potential adverse effects on patient health after discharge. The purpose of our study was to explore the association between components of the hospital discharge process including subsequent continuity of care and patient outcomes in the post-discharge period.
DESIGN
Systematic review of observational and interventional studies.
SETTING
We conducted a combined search in the Medline and Web of Science databases. Additional studies were identified by screening the bibliographies of the included studies. The data collection process was conducted using a standardised predefined grid that included quality criteria.
PARTICIPANTS
A standard patient population returning home after hospitalisation.
PRIMARY AND SECONDARY OUTCOMES
Adverse health outcomes occurring after hospital discharge.
RESULTS
In the 20 studies fulfilling our eligibility criteria, the main discharge-process components explored were: discharge summary (n=2), discharge instructions (n=2), drug-related problems at discharge (n=4), transition from hospital to home (n=5) and continuity of care after hospital discharge (n=7). The major subsequent patient health outcomes measured were: rehospitalisations (n=18), emergency department visits (n=8) and mortality (n=5). Eight of the 18 studies exploring rehospitalisations and two of the eight studies examining emergency department visits reported at least one significant association between the discharge process and these outcomes. None of the studies investigating patient mortality reported any significant such associations between the discharge process and these outcomes.
CONCLUSIONS
Irrespective of the component of the discharge process explored, the outcome considered (composite or not), the sample size and the study design, no consistent statistical association between hospital discharge and patient health outcome was identified. This systematic review highlights a wide heterogeneity between studies, especially in terms of the component(s) of the hospital discharge process investigated, study designs, outcomes and follow-up durations.
Topics: Emergency Service, Hospital; Hospitalization; Hospitals; Humans; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Transitional Care
PubMed: 28003282
DOI: 10.1136/bmjopen-2016-012287 -
Sante Publique (Vandoeuvre-les-Nancy,... 2015Communication between general practitioners (GPs) and hospitals is one of the weak points of our health system. Unfortunately, hospital discharge summaries, the... (Review)
Review
BACKGROUND
Communication between general practitioners (GPs) and hospitals is one of the weak points of our health system. Unfortunately, hospital discharge summaries, the cornerstone of this communication, tend to be poorly defined. The purpose of this study was to identify the key elements of hospital discharges ummaries, with particular attention to GP expectations.
METHOD
A systematic review of the international literature was conducted by searching Cochrane, Medline, Systeme universitaire de documentation (SUDoc) and Banque de donnees en santé publique (BDSP) databases as well as the French journals La Revue du Praticien, Prescrire and Exercer.
RESULTS
This database and journal review identified 10,551 publications, 38 of which were finally included in this analysis. The preferred maximum time to reception of the discharge summary was one week. This summary should not exceed four half pages. The desired content did not differ between GPs and hospital practitioners. GPs expressed the desire for a brief liaison letter given to the patient at the time of discharge. GPs expected the discharge summary to contain the reason for admission, treatment on discharge, the main diagnosis and subsequent management. A standardized and structured form was preferred, but a narrative form was not recommended. Special attention had to be paid to treatment on discharge and outstanding results at the time of discharge.
CONCLUSION
The elements identified from the literature will be used as a basis for a subsequent study designed to formalize discharge summaries for GPs.
Topics: Attitude of Health Personnel; Communication; Delivery of Health Care; France; General Practitioners; Humans; Patient Discharge
PubMed: 26752036
DOI: No ID Found -
Surgery For Obesity and Related... Mar 2023
Meta-Analysis
Topics: Humans; Gastric Bypass; Patient Discharge; Obesity, Morbid; Gastrectomy; Laparoscopy; Treatment Outcome
PubMed: 36379841
DOI: 10.1016/j.soard.2022.10.011 -
Surgery For Obesity and Related... Mar 2023
Meta-Analysis
Topics: Humans; Gastric Bypass; Patient Discharge; Obesity, Morbid; Gastrectomy; Laparoscopy; Treatment Outcome
PubMed: 36404227
DOI: 10.1016/j.soard.2022.10.013 -
Physical Therapy Mar 2021Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove...
OBJECTIVE
Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet, there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs.
METHODS
PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology Classification of Evidence scale for causation questions. American Academy of Neurology criteria were used to assess confidence in the evidence for each outcome.
RESULTS
Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function.
CONCLUSIONS
This systematic review concludes with moderate confidence that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions.
IMPACT
This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.
Topics: Humans; Length of Stay; Medicare; Patient Discharge; Patient Outcome Assessment; Patient Readmission; Physical Therapy Modalities; Skilled Nursing Facilities; United States
PubMed: 33388761
DOI: 10.1093/ptj/pzaa230 -
Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis.International Journal of Colorectal... Jun 2021Patients presenting with acute appendicitis are usually hospitalized for a few days for appendectomy and postoperative recovery. Shortening length of stay may reduce... (Meta-Analysis)
Meta-Analysis
PURPOSE
Patients presenting with acute appendicitis are usually hospitalized for a few days for appendectomy and postoperative recovery. Shortening length of stay may reduce costs and improve patient satisfaction. The purpose of this study was to assess the safety of same-day discharge after appendectomy for acute appendicitis.
METHODS
A systematic review was performed according to PRISMA guidelines. A literature search of EMBASE, Ovid MEDLINE, Web of Science, Cochrane Central, and Google Scholar was conducted from inception to April 14, 2020. Two reviewers independently screened the literature and selected studies that addressed discharge on the same calendar day as the appendectomy. Risk of bias was assessed with the ROBINS-I tool. Main outcomes were hospital readmission, complications, and unplanned hospital visits in the postoperative course. A random effects model was used to pool risk ratios for the main outcomes.
RESULTS
Of the 1912 articles screened, 17 comparative studies and 8 non-comparative studies met the inclusion criteria. Most only included laparoscopic procedure for uncomplicated appendicitis. Most studies were considered at moderate or serious risk of bias. In meta-analysis, same-day discharge (vs. overnight hospitalization) was not associated with increased rates of readmission, complication, and unplanned hospital visits. Non-comparative studies demonstrated low rates of readmission, complications, and unplanned hospital visits after same-day discharge.
CONCLUSION
This study suggests that same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis is safe without an increased risk of readmission, complications, or unplanned hospital visits. Hence, same-day discharge may be further encouraged in selected patients.
TRIAL REGISTRATION
PROSPERO registration no. CRD42018115948.
Topics: Appendectomy; Appendicitis; Humans; Laparoscopy; Length of Stay; Patient Discharge; Patient Readmission
PubMed: 33575890
DOI: 10.1007/s00384-021-03872-3 -
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