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PloS One 2018Unplanned hospital admissions in high-risk patients are common and costly in an increasingly frail chronic disease population. Virtual Wards (VW) are an emerging concept... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Unplanned hospital admissions in high-risk patients are common and costly in an increasingly frail chronic disease population. Virtual Wards (VW) are an emerging concept to improve outcomes in these patients.
PURPOSE
To evaluate the effect of post-discharge VWs, as an alternative to usual community based care, on hospital readmissions and mortality among heart failure and non-heart failure populations.
DATA SOURCES
Ovid MEDLINE, EMBASE, PubMed, the Cochrane Database of Systematic Reviews, SCOPUS and CINAHL, from inception through to Jan 31, 2017; unpublished data, prior systematic reviews; reference lists.
STUDY SELECTION
Randomized trials of post-discharge VW versus community based, usual care that reported all-cause hospital readmission and mortality outcomes.
DATA EXTRACTION
Data were reviewed for inclusion and independently extracted by two reviewers. Risk of bias was assessed using the Cochrane Collaboration risk of bias tool.
DATA SYNTHESIS
In patients with heart failure, a post-discharge VW reduced risk of mortality (six trials, n = 1634; RR 0.59, 95% CI = 0.44-0.78). Heart failure related readmissions were reduced (RR 0.61, 95% CI = 0.49-0.76), although all-cause readmission was not. In contrast, a post-discharge VW did not reduce death or hospital readmissions for patients with undifferentiated high-risk chronic diseases (four trials, n = .3186).
LIMITATIONS
Heterogeneity with respect to intervention and comparator, lacking consistent descriptions and utilization of standardized nomenclature for VW. Some trials had methodologic shortcomings and relatively small study populations.
CONCLUSIONS
A post-discharge VW can provide added benefits to usual community based care to reduce all-cause mortality and heart failure-related hospital admissions among patients with heart failure. Further research is needed to evaluate the utility of VWs in other chronic disease settings.
Topics: Chronic Disease; Continuity of Patient Care; Heart Failure; Humans; Length of Stay; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission
PubMed: 29708997
DOI: 10.1371/journal.pone.0196114 -
The Journal of the American Academy of... Aug 2019Identifying patient factors that affect length of stay (LOS) and discharge disposition after shoulder arthroplasty is key in managing patient expectations. In this...
INTRODUCTION
Identifying patient factors that affect length of stay (LOS) and discharge disposition after shoulder arthroplasty is key in managing patient expectations. In this systematic review, we identify patient-specific covariates that correlate with increased LOS and need for discharge to a facility.
METHODS
We searched biomedical databases to identify associations between patient-specific factors and LOS and discharge disposition after shoulder arthroplasty. We included all studies involving hemiarthroplasty, anatomic shoulder arthroplasty, and reverse shoulder arthroplasty. Reported patient and provider factors were evaluated for their association with increased LOS and discharge to a facility.
RESULTS
Twenty-two studies were identified. Age >65 years, female sex, obesity, and reverse shoulder arthroplasty were associated with extended LOS and correlated with discharge to a facility. Greater hospital and surgeon volume were associated with decreased LOS and decreased risk of discharge to a facility. Local injection of liposomal bupivacaine combined with intravenous dexamethasone was associated with reduced LOS.
DISCUSSION
Patient factors affecting LOS and likelihood of discharge to a facility include age >65 years, female sex, diabetes, obesity, and reverse shoulder arthroplasty. These factors can be used to develop studies to preoperatively predict outcomes after shoulder arthroplasty and to help identify patients who may be at risk of prolonged postoperative admission.
LEVEL OF EVIDENCE
Prognostic level IV.
Topics: Age Factors; Arthroplasty, Replacement, Shoulder; Comorbidity; Humans; Length of Stay; Patient Discharge; Sex Factors
PubMed: 30499894
DOI: 10.5435/JAAOS-D-18-00244 -
Journal of Public Health (Oxford,... Mar 2012Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable... (Review)
Review
INTRODUCTION
Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain.
METHODS
Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries.
RESULTS
Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3-92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3-94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7-88.7%). There was considerable variation in accuracy rates between studies (50.5-97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3-92.1%) to 96.0% (IQR: 89.3-96.3), P= 0.020.
CONCLUSION
Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making.
Topics: Clinical Coding; Databases, Bibliographic; Humans; Patient Discharge; Registries; Reproducibility of Results; State Medicine; United Kingdom
PubMed: 21795302
DOI: 10.1093/pubmed/fdr054 -
Journal of Psychiatric and Mental... Aug 2021Family members and friends (informal carers) are very important for providing support to people with mental health difficulties. When these carers are included to care... (Review)
Review
WHAT IS KNOWN ON THE SUBJECT
Family members and friends (informal carers) are very important for providing support to people with mental health difficulties. When these carers are included to care planning patients seem to benefit, as they are less likely to relapse.
WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE
There are three types of interventions including carers in the patients'transition 1) programmes that offer education in hospital; 2) programmes that involve carers in planning the patients discharge; and 3) programmes that involve carers in hospital care, discharge planning and also follow-up in the community. Interventions including carers that take place both in the hospital and the community have the clearest evidence for benefit on relapse reduction.
WHAT ARE THE IMPLICATIONS FOR PRACTICE
Comprehensive interventions have the best evidence for effectiveness but challenges in their implementation and resourcing should be considered. It might worth trying to identify and test simpler interventions focusing on discharge planning that can be used in busy services and require more limited resources whilst providing opportunities for the participation of carers.
ABSTRACT
INTRODUCTION: Involving informal carers (family and friends of patients) in mental health interventions can lead to positive clinical and psychosocial outcomes such as relapse prevention or treatment adherence.
AIM/QUESTION
To explore the evidence on the effectiveness of different models that involve carers in the transition between hospital and community mental health care.
METHODS
Five electronic databases (PsycINFO, CINAHL, MEDLINE, Embase and Scopus) and Grey literature (Open Grey and Grey Literature report) were systematically searched. The results were analysed using a narrative synthesis.
RESULTS
Fourteen papers were identified. They described twelve interventions that were categorized into three groups: 1) purely educational programmes in preparation of discharge; 2) programmes that involved carers in planning the transition from the mental health inpatient treatment to community mental health services; and 3) programmes that bridged into the aftercare involving carers in community follow-up. The most comprehensive interventions, i.e. those including psychoeducation, care planning and aftercare follow-up were better evaluated and showed a clearer benefit in improving long-term outcomes and, in particular, reduce re-hospitalization.
IMPLICATIONS FOR PRACTICE
Comprehensive interventions showed the clearest benefit in improving long-term clinical outcomes of patients. Future research should explore implementation, costs and cost-effectiveness, as comprehensive interventions delivered across different settings are likely to require wide-ranging organizational changes and significant resources.
Topics: Caregivers; Community Mental Health Services; Hospitals; Humans; Mental Health; Patient Discharge
PubMed: 33053271
DOI: 10.1111/jpm.12701 -
International Journal of Gynaecology... Feb 2017Same-day discharge has been suggested to safe and acceptable following minimally invasive hysterectomy. (Review)
Review
BACKGROUND
Same-day discharge has been suggested to safe and acceptable following minimally invasive hysterectomy.
OBJECTIVES
To evaluate the feasibility of same-day discharge following minimally invasive hysterectomy and to identify associated factors.
SEARCH STRATEGY
Medline, Embase and the Cochrane Central Register of Controlled Trials were systematically searched using the terms "same day discharge", "minimally invasive surgery", and "hysterectomy" between October 1 and October 31, 2015. No language or publication date restrictions were included.
SELECTION CRITERIA
Randomized controlled trials and observational studies evaluating same-day discharge before midnight on the day of minimally invasive hysterectomy were included.
DATA COLLECTION AND ANALYSIS
Study characteristics, pre-operative selection criteria, and predictive factors for same-day discharge were analyzed.
MAIN RESULTS
There were 15 observational studies with 11 992 patients included. Significant heterogeneity was observed in the studies, and publication and selection bias could have potentially affected the results. All the studies concluded that same-day discharge was feasible. However, some factors were associated with a decreased possibility of same-day discharge; these were older age, beginning surgery later than 1:00 pm and completing surgery later than 6:00 pm, longer duration of operation, and high estimated blood loss.
CONCLUSIONS
Same-day discharge appears feasible for a majority of patients who undergo minimally invasive hysterectomies if adequate emphasis is placed on pre-surgical planning and careful patient selection.
Topics: Age Factors; Female; Humans; Hysterectomy; Minimally Invasive Surgical Procedures; Operative Time; Patient Discharge; Patient Readmission; Postoperative Complications; Robotic Surgical Procedures
PubMed: 28099736
DOI: 10.1002/ijgo.12023 -
Journal of Global Health Dec 2022All term healthy neonates are screened for jaundice before hospital discharge as a standard clinical practice, but methods vary from clinical screening (visual... (Meta-Analysis)
Meta-Analysis
BACKGROUND
All term healthy neonates are screened for jaundice before hospital discharge as a standard clinical practice, but methods vary from clinical screening (visual inspection and/or risk factor assessment) to transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) testing, depending on the setting.
METHODS
This systematic review of randomized and non-randomized studies evaluated the effectiveness of universal TcB and universal TSB screening at discharge compared to clinical screening alone for term healthy neonates. The outcomes were neonatal mortality, readmission for jaundice, severe hyperbilirubinemia (>20 mg/dL), jaundice requiring exchange transfusion, and bilirubin-induced neurological dysfunction (BIND). We searched MEDLINE via Ovid, EBM reviews, Embase, CINAHL, clinical trials databases, and reference lists of retrieved articles. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) for randomized and odds ratio (OR) for non-randomized studies.
RESULTS
For universal TcB at discharge, we included one randomized trial enrolling 1858 participants and four non-randomized studies enrolling 375 956 participants. No study reported neonatal mortality. The randomized trial suggested that universal TcB at discharge may decrease readmission for jaundice (risk ratio (RR) = 0.24, 95% confidence interval (CI) = 0.13 to 0.46; low certainty evidence) and severe hyperbilirubinemia (RR = 0.27, 95% CI = 0.08 to 0.97; low certainty evidence), but the effect on jaundice requiring exchange transfusion (RR = 0.20, 95% CI = 0.01 to 41.6) and BIND (RR = 0.33, 95% CI = 0.01 to 8.17) was uncertain. Meta-analysis of non-randomized studies suggested that TcB may decrease severe hyperbilirubinemia (odds ratio (OR) = 0.25, 95% = CI 0.12 to 0.52; low certainty evidence) and jaundice requiring exchange transfusion (OR = 0.28, 95% CI = 0.19 to 0.42; low certainty evidence), but the effect on readmission for jaundice was uncertain (OR = 1.01, 95% CI = 0.38 to 2.7; very low certainty evidence). For universal TSB, we included three studies from the United States enrolling 490 426 participants. The effect on severe hyperbilirubinemia (OR = 0.37, 95% CI = 0.15 to 0.88), jaundice requiring exchange transfusion (OR = 0.53, 95% CI = 0.13 to 2.25) and readmission for jaundice (OR = 1.01, 95% CI = 0.62 to 1.67) was uncertain.
CONCLUSIONS
Universal TcB at discharge may improve clinical outcomes for term healthy neonates. Evidence for universal TSB is uncertain.
REGISTRATION
PROSPERO 2020 CRD42020187279.
Topics: Infant, Newborn; Humans; United States; Patient Discharge; Bilirubin; Hyperbilirubinemia; Jaundice
PubMed: 36579719
DOI: 10.7189/jogh.12.12007 -
Respiratory Medicine Mar 2024Earlier reviews of exercise in people during exacerbation of chronic obstructive pulmonary disease (COPD) included studies where exercise training was initiated late... (Meta-Analysis)
Meta-Analysis Review
Exercise training initiated early during hospitalisation in individuals with chronic obstructive pulmonary disease is safe and improves exercise capacity and physical function at hospital discharge: A systematic review and meta-analysis.
BACKGROUND AND OBJECTIVE
Earlier reviews of exercise in people during exacerbation of chronic obstructive pulmonary disease (COPD) included studies where exercise training was initiated late during hospital admission or shortly following hospital discharge. Our question was: in adults hospitalised with an exacerbation of COPD, does initiating exercise training early during an admission versus not initiating exercise training during admission, change outcomes measured at discharge?
METHODS
Systematic review and meta-analysis. Database searches of PubMed, the Cochrane Library, PEDro and EMBASE conducted in December 2021 and updated in January 2024. Studies were included if they had at least one group that was prescribed exercise training within 48 h of hospital admission (experimental) and at least one group that received usual care which did not include prescribed exercise training (control). Outcomes included exercise capacity, physical function, adverse events and uptake of outpatient pulmonary rehabilitation programs.
RESULTS
Ten studies (423 participants; mean FEV ranging from 26 % to 50 % predicted) were included. At discharge, compared to the control group, the experimental group demonstrated better exercise capacity (standardised mean difference (SMD) 0.58, 95 % confidence interval (CI) 0.32 to 0.83; five studies, moderate effect, low certainty evidence) and physical function (SMD -0.54, 95 % CI -0.86 to -0.22; four studies, moderate effect, low certainty evidence). No observed serious adverse events were reported. None of the studies reported uptake of pulmonary rehabilitation following discharge.
CONCLUSION
In adults with an exacerbation of COPD, exercise training prescribed within 48 h of hospitalisation was safe and improved exercise capacity and physical function.
Topics: Adult; Humans; Patient Discharge; Exercise Tolerance; Hospitalization; Exercise; Pulmonary Disease, Chronic Obstructive; Hospitals; Quality of Life
PubMed: 38307320
DOI: 10.1016/j.rmed.2024.107554 -
Journal of General Internal Medicine May 2020Interhospital fragmentation of care occurs when patients are admitted to different, disconnected hospitals. It has been hypothesized that this type of care fragmentation... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Interhospital fragmentation of care occurs when patients are admitted to different, disconnected hospitals. It has been hypothesized that this type of care fragmentation decreases the quality of care received and increases hospital costs and healthcare utilization. This systematic review aims to synthesize the existing literature exploring the association between interhospital fragmentation of care and patient outcomes.
METHODS
MEDLINE, the Cochrane Library, EMBASE, and the Science Citation Index were systematically searched for studies published up to April 30, 2018 reporting the association between interhospital fragmentation of care and patient outcomes. We included peer-reviewed observational studies conducted in adults that reported measures of association between interhospital care fragmentation and one or more of the following patient outcomes: mortality, hospital length of stay, cost, and subsequent hospital readmission.
RESULTS
Seventy-nine full texts were reviewed and 22 met inclusion criteria. Nearly all studies defined fragmentation of care as a readmission to a different hospital than the patient was previously discharged from. The strongest association reported was that between a fragmented readmission and in-hospital or short-term mortality (adjusted odds ratio range 0.95-3.62). Over half of the studies reporting length-of-stay showed longer length of stay in fragmented readmissions. All three studies that investigated healthcare utilization suggested an association between fragmented care and odds of subsequent readmission. The study populations and exposures were too heterogenous to perform a meta-analysis.
DISCUSSION
Our review suggests that fragmented hospital readmissions contribute to increased mortality, longer length-of-stay, and increased risk of readmission to the hospital.
Topics: Adult; Hospital Mortality; Hospitalization; Humans; Length of Stay; Patient Discharge; Patient Readmission
PubMed: 31625038
DOI: 10.1007/s11606-019-05366-z -
BMC Geriatrics Jul 2013Older age and higher acuity are associated with prolonged hospital stays and hospital readmissions. Early discharge planning may reduce lengths of hospital stay and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Older age and higher acuity are associated with prolonged hospital stays and hospital readmissions. Early discharge planning may reduce lengths of hospital stay and hospital readmissions; however, its effectiveness with acutely admitted older adults is unclear.
METHODS
In this systematic review, we compared the effectiveness of early discharge planning to usual care in reducing index length of hospital stay, hospital readmissions, readmission length of hospital stay, and mortality; and increasing satisfaction with discharge planning and quality of life for older adults admitted to hospital with an acute illness or injury.We searched the Cochrane Library, DARE, HTA, NHSEED, ACP, MEDLINE, EMBASE, CINAHL, Proquest Dissertations and Theses, PubMed, Web of Science, SciSearch, PEDro, Sigma Theta Tau International's registry of nursing research, Joanna Briggs Institute, CRISP, OT Seeker, and several internet search engines. Hand-searching was conducted in four gerontological journals and references of all included studies and previous systematic reviews. Two reviewers independently extracted data and assessed risk of bias. Data were pooled using a random-effects meta-analysis. Where meta-analysis was not possible, narrative analysis was performed.
RESULTS
Nine trials with a total of 1736 participants were included. Compared to usual care, early discharge planning was associated with fewer hospital readmissions within one to twelve months of index hospital discharge [risk ratio (RR) = 0.78, 95% CI = 0.69 - 0.90]; and lower readmission lengths of hospital stay within three to twelve months of index hospital discharge [weighted mean difference (WMD) = -2.47, 95% confidence intervals (CI) = -4.13 - -0.81)]. No differences were found in index length of hospital stay, mortality or satisfaction with discharge planning. Narrative analysis of four studies indicated that early discharge planning was associated with greater overall quality of life and the general health domain of quality of life two weeks after index hospital discharge.
CONCLUSIONS
Early discharge planning with acutely admitted older adults improves system level outcomes after index hospital discharge. Service providers can use these findings to design and implement early discharge planning for older adults admitted to hospital with an acute illness or injury.
Topics: Acute Disease; Aged; Aged, 80 and over; Hospitalization; Humans; Patient Discharge; Time Factors; Treatment Outcome; Wounds and Injuries
PubMed: 23829698
DOI: 10.1186/1471-2318-13-70 -
Vascular Health and Risk Management 2017We aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of... (Meta-Analysis)
Meta-Analysis Review
AIM
We aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of re-infarction, revascularization, stroke, death, and incidence of rehospitalization. We also aimed to compare costs for the two strategies.
METHODS
The study was a systematic review and a meta-analysis of 12 randomized controlled trials including 2962 patients, followed by trial sequential analysis. An estimation of cost was considered. Follow-up time was 30 days.
RESULTS
For early discharge, pooled effect for the composite endpoint was relative risk of efficacy (RRe)=0.65, 95% confidence interval (CI) (0.52-0.81). Rehospitalization had a pooled effect of RRe=1.10, 95% CI (0.88-1.38). Early discharge had an increasing risk of rehospitalization with increasing frequency of hypertension for all populations, except those with stable angina, where a decreasing risk was noted. Advancing age gave increased risk of revascularization. Early discharge had a cost reduction of 655 Euros per patient compared with ordinary discharge.
CONCLUSION
The pooled effect supports the safe use of early discharge after PCI in the treatment of a heterogeneous population of patients with coronary artery disease. There was an increased risk of rehospitalization for all subpopulations, except patients with stable angina. Clinical trials with homogeneous populations of acute coronary syndrome are needed to be conclusive on this issue.
Topics: Aged; Cost-Benefit Analysis; Female; Hospital Costs; Humans; Length of Stay; Male; Middle Aged; Myocardial Ischemia; Patient Discharge; Patient Readmission; Percutaneous Coronary Intervention; Process Assessment, Health Care; Randomized Controlled Trials as Topic; Retreatment; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 28356750
DOI: 10.2147/VHRM.S122951