Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review

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Impact of transitional care interventions on hospital readmissions in older medical patients : a systematic review. / Rasmussen, Lisa Fønss; Grode, Louise Bang; Lange, Jeppe; Barat, Ishay; Gregersen, Merete.

In: BMJ Open, Vol. 11, No. 1, e040057, 01.2021.

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@article{a0931009c2ff46e986febdd91e82bcf4,
title = "Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review",
abstract = "OBJECTIVES: To identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients.DESIGN: A systematic review.METHOD: Inclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated.RESULT: We identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre-post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7-182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor.CONCLUSION: Transitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions.PROSPERO REGISTRATION NUMBER: CRD42019121795.",
keywords = "geriatric medicine, internal medicine, preventive medicine, DISCHARGE, EMERGENCY-DEPARTMENT, ADULTS, RISK, RANDOMIZED CONTROLLED-TRIAL, PROGRAM",
author = "Rasmussen, {Lisa F{\o}nss} and Grode, {Louise Bang} and Jeppe Lange and Ishay Barat and Merete Gregersen",
note = "{\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2021",
month = jan,
doi = "10.1136/bmjopen-2020-040057",
language = "English",
volume = "11",
journal = "B M J Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "1",

}

RIS

TY - JOUR

T1 - Impact of transitional care interventions on hospital readmissions in older medical patients

T2 - a systematic review

AU - Rasmussen, Lisa Fønss

AU - Grode, Louise Bang

AU - Lange, Jeppe

AU - Barat, Ishay

AU - Gregersen, Merete

N1 - © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/1

Y1 - 2021/1

N2 - OBJECTIVES: To identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients.DESIGN: A systematic review.METHOD: Inclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated.RESULT: We identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre-post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7-182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor.CONCLUSION: Transitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions.PROSPERO REGISTRATION NUMBER: CRD42019121795.

AB - OBJECTIVES: To identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients.DESIGN: A systematic review.METHOD: Inclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated.RESULT: We identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre-post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7-182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor.CONCLUSION: Transitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions.PROSPERO REGISTRATION NUMBER: CRD42019121795.

KW - geriatric medicine

KW - internal medicine

KW - preventive medicine

KW - DISCHARGE

KW - EMERGENCY-DEPARTMENT

KW - ADULTS

KW - RISK

KW - RANDOMIZED CONTROLLED-TRIAL

KW - PROGRAM

UR - http://www.scopus.com/inward/record.url?scp=85099261519&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2020-040057

DO - 10.1136/bmjopen-2020-040057

M3 - Review

C2 - 33419903

VL - 11

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 1

M1 - e040057

ER -