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JAMA Network Open Aug 2021Shortcomings in the education of patients at hospital discharge are associated with higher risks for treatment failure and hospital readmission. Whether improving... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Shortcomings in the education of patients at hospital discharge are associated with higher risks for treatment failure and hospital readmission. Whether improving communication at discharge through specific interventions has an association with patient-relevant outcomes remains unclear.
OBJECTIVE
To conduct a systematic review and meta-analysis on the association of communication interventions at hospital discharge with readmission rates and other patient-relevant outcomes.
DATA SOURCES
PubMed, EMBASE, PsycINFO, and CINAHL were systematically searched from the inception of each database to February 28, 2021.
STUDY SELECTION
Randomized clinical trials that randomized patients to receiving a discharge communication intervention or a control group were included.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data on outcomes and trial and patient characteristics. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Data were pooled using a random-effects model, and risk ratios (RRs) with corresponding 95% CIs are reported. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
MAIN OUTCOMES AND MEASURES
The primary outcome was hospital readmission, and secondary outcomes included adherence to treatment regimen, patient satisfaction, mortality, and emergency department reattendance 30 days after hospital discharge.
RESULTS
We included 60 randomized clinical trials with a total of 16 070 patients for the qualitative synthesis and 19 trials with a total of 3953 patients for the quantitative synthesis of the primary outcome. Of these, 11 trials had low risk of bias, 6 trials had high risk of bias, and 2 trials had unclear risk of bias. Communication interventions at discharge were significantly associated with lower readmission rates (179 of 1959 patients [9.1%] in intervention groups vs 270 of 1994 patients [13.5%] in control groups; RR, 0.69; 95% CI, 0.56-0.84), higher adherence to treatment regimen (1729 of 2009 patients [86.1%] in intervention groups vs 1599 of 2024 patients [79.0%] in control groups; RR, 1.24; 95% CI, 1.13-1.37), and higher patient satisfaction (1187 of 1949 patients [60.9%] in intervention groups vs 991 of 2002 patients [49.5%] in control groups; RR, 1.41; 95% CI, 1.20-1.66).
CONCLUSIONS AND RELEVANCE
These findings suggest that communication interventions at discharge are significantly associated with fewer hospital readmissions, higher treatment adherence, and higher patient satisfaction and thus are important to facilitate the transition of care.
Topics: Adult; Aged; Aged, 80 and over; Communication; Female; Humans; Male; Middle Aged; Patient Discharge; Patient Education as Topic; Patient Readmission; Practice Guidelines as Topic
PubMed: 34448868
DOI: 10.1001/jamanetworkopen.2021.19346 -
JAMA Psychiatry Jul 2017High rates of suicide after psychiatric hospitalization are reported in many studies, yet the magnitude of the increases and the factors underlying them remain unclear. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
High rates of suicide after psychiatric hospitalization are reported in many studies, yet the magnitude of the increases and the factors underlying them remain unclear.
OBJECTIVES
To quantify the rates of suicide after discharge from psychiatric facilities and examine what moderates those rates.
DATA SOURCES
English-language, peer-reviewed publications published from January 1, 1946, to May 1, 2016, were located using MEDLINE, PsychINFO, and EMBASE with the search terms ((suicid*).ti AND (hospital or discharg* OR inpatient or in-patient OR admit*).ab and ((mortality OR outcome* OR death*) AND (psych* OR mental*)).ti AND (admit* OR admis* or hospital* OR inpatient* OR in-patient* OR discharg*).ab. Hand searching was also done.
STUDY SELECTION
Studies reporting the number of suicides among patients discharged from psychiatric facilities and the number of exposed person-years and studies from which these data could be calculated.
DATA EXTRACTION AND SYNTHESIS
The meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. A random-effects model was used to calculate a pooled estimate of postdischarge suicides per 100 000 person-years.
MAIN OUTCOMES AND MEASURES
The suicide rate after discharge from psychiatric facilities was the main outcome, and the association between the duration of follow-up and the year of the sampling were the main a priori moderators.
RESULTS
A total of 100 studies reported 183 patient samples (50 samples of females, 49 of males, and 84 of mixed sex; 129 of adults or unspecified patients, 20 of adolescents, 19 of older patients, and 15 from long-term or forensic discharge facilities), including a total of 17 857 suicides during 4 725 445 person-years. The pooled estimate postdischarge suicide rate was 484 suicides per 100 000 person-years (95% CI, 422-555 suicides per 100 000 person-years; prediction interval, 89-2641), with high between-sample heterogeneity (I2 = 98%). The suicide rate was highest within 3 months after discharge (1132; 95% CI, 874-1467) and among patients admitted with suicidal ideas or behaviors (2078; 95% CI, 1512-2856). Pooled suicide rates per 100 000 patients-years were 654 for studies with follow-up periods of 3 months to 1 year, 494 for studies with follow-up periods of 1 to 5 years, 366 for studies with follow-up periods of 5 to 10 years, and 277 for studies with follow-up periods longer than 10 years. Suicide rates were higher among samples collected in the periods 1995-2004 (656; 95% CI, 518-831) and 2005-2016 (672; 95% CI, 428-1055) than in earlier samples.
CONCLUSIONS AND RELEVANCE
The immediate postdischarge period is a time of marked risk, but rates of suicide remain high for many years after discharge. Patients admitted because of suicidal ideas or behaviors and those in the first months after discharge should be a particular focus of concern. Previously admitted patients should be able to access long-term care and assistance.
Topics: Hospitals, Psychiatric; Humans; Patient Discharge; Suicide
PubMed: 28564699
DOI: 10.1001/jamapsychiatry.2017.1044 -
The Lancet. Digital Health Mar 2023
Topics: Humans; Patient Discharge
PubMed: 36754724
DOI: 10.1016/S2589-7500(23)00021-3 -
BMC Geriatrics Mar 2020Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions... (Randomized Controlled Trial)
Randomized Controlled Trial
Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial.
BACKGROUND
Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations.
TRIAL DESIGN AND METHODS
This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics.
RESULTS
Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization (p = 0.003) and ED presentations (p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations (p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles (p = 0.019), the participation observed in HOME patients with no support was not significantly improved.
CONCLUSIONS
Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home.
TRIAL REGISTRATION
The trial was registered before commencement (ACTRN12611000615987).
Topics: Activities of Daily Living; Aftercare; Aged; Aged, 80 and over; Australia; Cognitive Dysfunction; Female; Humans; Male; Occupational Therapy; Outcome and Process Assessment, Health Care; Patient Discharge; Patient-Centered Care; Treatment Outcome
PubMed: 32122311
DOI: 10.1186/s12877-020-1494-3 -
Laeknabladid
Topics: Humans; Patient Discharge
PubMed: 31571603
DOI: 10.17992/lbl.2019.10.248 -
Revista Brasileira de Enfermagem Apr 2017Stroke still causes high levels of human inability and suffering, and it is one of the main causes of death in developed countries, including Portugal. (Review)
Review
UNLABELLED
Stroke still causes high levels of human inability and suffering, and it is one of the main causes of death in developed countries, including Portugal.
OBJECTIVE
analyze the strategies of hospital discharge planning for these patients, increasing the knowledge related to hospitalhome transition, discharge planning processes and the main impact on the quality of life and functionality.
METHOD
integrative literature review using the PICOD criteria, with database research.
RESULTS
19 articles were obtained, using several approaches and contexts. For quality of life, the factors related to the patient satisfaction with care and the psychoemotional aspects linked with functionality are the most significant.
CONCLUSION
during the hospitalization period, a careful hospital discharge planning and comprehensive care to patients and caregivers - in particular the functional and psychoemotional aspects - tend to have an impact on the quality of life of patients.
Topics: Activities of Daily Living; Humans; Patient Discharge; Patient Satisfaction; Quality of Life; Stroke
PubMed: 28403308
DOI: 10.1590/0034-7167-2016-0166 -
Revista Medica de Chile Feb 2014Discharge is one of the most important processes that hospitalized patients must endure. This process is complex, requires coordination among several professionals and... (Review)
Review
Discharge is one of the most important processes that hospitalized patients must endure. This process is complex, requires coordination among several professionals and transfers an overwhelming amount of information to patients. Often, it is limited to the writing of the discharge summary, with a primary emphasis on the drug list. Since the rise of hospitalism in 1996, a greater emphasis has been placed on understanding this process and in developing interventions to make it more effective and safe. In our country, little is known about how this process is taking place. Probably the absence of financial penalties for readmissions has influenced in the lack of study and development of this process. In the USA the knowledge of the discharge process is well advanced, and several strategies have been developed for reducing adverse events, medication errors, and 30-days readmissions. Other interventions have increased patient satisfaction and the degree of knowledge about their conditions. The aim of this paper is to do a comprehensive review of the literature, to provide healthcare teams with various tools that could improve both the discharge process as well as the discharge summary. The final objective is to optimize the safety and satisfaction of our patients and the hospital metrics of quality.
Topics: Humans; Medication Errors; Patient Discharge; Patient Readmission
PubMed: 24953112
DOI: 10.4067/S0034-98872014000200012 -
Chest Feb 2015We conducted a scoping review to systematically review the literature reporting patient discharge from ICUs, identify facilitators and barriers to high-quality care, and... (Review)
Review
BACKGROUND
We conducted a scoping review to systematically review the literature reporting patient discharge from ICUs, identify facilitators and barriers to high-quality care, and describe tools developed to improve care.
METHODS
We searched Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Data were extracted on the article type, study details for research articles, patient population, phase of care during discharge, and dimensions of health-care quality.
RESULTS
From 8,154 unique publications we included 224 articles. Of these, 131 articles (58%) were original research, predominantly case series (23%) and cohort (16%) studies; 12% were narrative reviews; and 11% were guidelines/policies. Common themes included patient and family needs/experiences (29% of articles) and the importance of complete and accurate information (26%). Facilitators of high-quality care included provider-patient communication (30%), provider-provider communication (25%), and the use of guidelines/policies (29%). Patient and family anxiety (21%) and limited availability of ICU and ward resources (26%) were reported barriers to high-quality care. A total of 47 tools to facilitate patient discharge from the ICU were identified and focused on patient evaluation for discharge (29%), discharge planning and teaching (47%), and optimized discharge summaries (23%).
CONCLUSIONS
Common themes, facilitators and barriers related to patient and family needs/experiences, communication, and the use of guidelines/policies to standardize patient discharge from ICU transcend the literature. Candidate tools to improve care are available; comparative evaluation is needed prior to broad implementation and could be tested through local quality-improvement programs.
Topics: Communication; Guidelines as Topic; Humans; Intensive Care Units; Patient Discharge; Physician-Patient Relations; Process Assessment, Health Care; Quality of Health Care
PubMed: 25210942
DOI: 10.1378/chest.13-2965 -
Healthcare Policy = Politiques de Sante Nov 2016Discharge prediction is designed to streamline inpatient flow and reduce hospital overcrowding without adding capacity. This study's objective was to describe the... (Review)
Review
AIMS AND OBJECTIVES
Discharge prediction is designed to streamline inpatient flow and reduce hospital overcrowding without adding capacity. This study's objective was to describe the literature on discharge prediction and assess its usefulness in evaluating the implementation and outcomes of discharge prediction projects.
METHODS
The authors reviewed the current peer-reviewed and grey literature on discharge prediction projects in acute care hospitals. Project descriptions were analyzed using Donabedian's structure-process-outcome model for evaluating complex healthcare innovations.
RESULTS
The review revealed a paucity of literature on the use and effectiveness of discharge prediction. There is high variation in its use and generally poor reporting of both implementation and outcomes.
CONCLUSIONS
The literature on discharge prediction generally lacks the descriptive detail that would be useful to parties considering or planning a discharge prediction initiative. Further study is required to determine how best to integrate these prediction tools into acute care hospitals.
Topics: Adult; Critical Care; Decision Making; Female; Forecasting; Humans; Male; Middle Aged; Outcome and Process Assessment, Health Care; Patient Discharge
PubMed: 28032828
DOI: No ID Found -
Journal of Hospital Medicine Apr 2015
Topics: Bronchiolitis; Female; Humans; Length of Stay; Male; Patient Discharge
PubMed: 25627958
DOI: 10.1002/jhm.2323