Article Text

Original research
Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review
  1. Lisa Fønss Rasmussen1,2,
  2. Louise Bang Grode1,
  3. Jeppe Lange2,3,
  4. Ishay Barat1,2,
  5. Merete Gregersen4
  1. 1Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
  2. 2Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
  3. 3Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
  4. 4Departments of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Lisa Fønss Rasmussen; lirasm{at}rm.dk

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.

  • geriatric medicine
  • preventive medicine
  • internal medicine
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Footnotes

  • Contributors All authors listed have contributed sufficiently to the project to be included as authors according to the Vancouver Guideline. All authors have participated in the development of the study, writing the draft and all have approved the final version. LFR: first author writing the manuscript, screening records for inclusion, data extraction of included studies, quality assessment of included studies. LBG, JL, IB, MG: initial development of the study, screening records for inclusion, data extraction of included studies, quality assessment of included studies, reading and giving feedback on the manuscript and approving the final manuscript.

  • Funding This work was supported by the ‘Fund for advancement of health research in Central Denmark Region’. Grant number N/A.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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