Preventing 30-day hospital readmissions: A systematic review and meta-analysis of randomized trials

JAMA Internal Medicine

Volumn 174, Issue 7, 2014, Pages 1095-1107

  Leppin, Aaron L ^a   Gionfriddo, Michael R ^a,b   Kessler, Maya ^a   Brito, Juan Pablo ^a   Mair, Frances S ^c   Gallacher, Katie ^c   Wang, Zhen ^a   Erwin, Patricia J ^a   Sylvester, Tanya ^d   Boehmer, Kasey ^a,e   Ting, Henry H ^a   Murad, M Hassan ^a   Shippee, Nathan D ^e   Montori, Victor M ^a  

^a MAYO CLINIC   (United States)

^b MAYO GRADUATE SCHOOL   (United States)

^c UNIVERSITY OF GLASGOW   (United Kingdom)

^d SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^e UNIVERSITY OF MINNESOTA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CAREGIVER; DAY HOSPITAL; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE QUALITY; HOSPITAL READMISSION; HOSPITALIZATION; HUMAN; OUT OF HOSPITAL CARDIAC ARREST; POLICY; PRIORITY JOURNAL; REVIEW; RISK FACTOR; SELF CARE; SYSTEMATIC REVIEW;

HUMANS; MODELS, THEORETICAL; PATIENT DISCHARGE; PATIENT READMISSION; QUALITY OF HEALTH CARE; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 84904128037     PISSN: 21686106     EISSN: None     Source Type: Journal    
DOI: 10.1001/jamainternmed.2014.1608     Document Type: Review

References (66)

1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360 (14):1418-1428.
2. Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: National Academies Press; 2006.
3. Medicare Payment Advisory Commission. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: Medicare Payment Advisory Commission; 2007.
4. Joynt KE, Jha AK. A path forward on Medicare readmissions. N Engl J Med. 2013;368(13):1175-1177.
5. Shippee ND, Shah ND, May CR, Mair FS, Montori VM. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J Clin Epidemiol. 2012;65(10):1041-1051.
6. Gallacher K, May CR, Montori VM, Mair FS. Understanding patients' experiences of treatment burden in chronic heart failure using normalization process theory. Ann Fam Med. 2011;9(3):235-243.
7. Sav A, Kendall E, McMillan SS, et al. 'You say treatment, I say hard work': treatment burden among people with chronic illness and their carers in Australia. Health Soc Care Community. 2013;21(6):665-674.
8. Krumholz HM. Post-hospital syndrome - an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100-102.
9. Leppin AL, Ting HH, Gionfriddo MR, et al. Describing the usefulness and efficacy of discharge interventions: predicting 30 day readmissions through application of the cumulative complexity model (protocol). 2013. http://kerunit.files.wordpress.com/2011/07/ccm-readmissions-protocol11.docx. Accessed September 1, 2013.
10. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
11. Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155(8):520-528.
12. Higgins JP, Altman DG, Gøtzsche PC, et al Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
13. Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54(10):1046-1055. (Pubitemid 32888370)
14. DerSimonian R, Kacker R. Random-effects model formeta-analysis of clinical trials: an update. Contemp Clin Trials. 2007;28(2):105-114. (Pubitemid 44937874)
15. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719-748.
16. 2 tests. Biometrics. 1954;10:417-451.
17. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency inmeta-analyses. BMJ. 2003;327(7414):557-560.
18. Herrera-Espiñeira C, Rodríguez del Águila MdelM, Navarro Espigares JL, et al. Effect of a telephone care program after hospital discharge from a trauma surgery unit [in Spanish]. Gac Sanit. 2011;25(2):133-138.
19. Melton LD, Foreman C, Scott E, McGinnis M, Cousins M. Prioritized post-discharge telephonic outreach reduces hospital readmissions for select high-risk patients. Am J Manag Care. 2012;18(12):838-844.
20. Marusic S, Gojo-Tomic N, Erdeljic V, et al. The effect of pharmacotherapeutic counseling on readmissions and emergency department visits. Int J Clin Pharm. 2013;35(1):37-44.
21. Altfeld SJ, Shier GE, Rooney M, et al. Effects of an enhanced discharge planning intervention for hospitalized older adults: a randomized trial. Gerontologist. 2013;53(3):430-440.
22. Davis KK, Mintzer M, Dennison Himmelfarb CR, Hayat MJ, Rotman S, Allen J. Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment. Eur J Heart Fail. 2012;14(9):1041-1049.
23. Bowles KH, Hanlon AL, Glick HA, et al. Clinical effectiveness, access to, and satisfaction with care using a telehomecare substitution intervention: a randomized controlled trial. Int J Telemed Appl. 2011;2011:540138.
24. Finn KM, Heffner R, Chang Y, et al. Improving the discharge process by embedding a discharge facilitator in a resident team. J Hosp Med. 2011;6(9):494-500.
25. Wong FK, Ho MM, Yeung S, Tam SK, Chow SK. Effects of a health-social partnership transitional program on hospital readmission: a randomized controlled trial. Soc Sci Med. 2011;73(7):960-969.
26. Leventhal ME, Denhaerynck K, Brunner-La Rocca HP, et al. Swiss Interdisciplinary Management Programme for Heart Failure (SWIM-HF): a randomised controlled trial study of an outpatient inter-professional management programme for heart failure patients in Switzerland. Swiss Med Wkly. 2011;141:w13171.
27. Rytter L, Jakobsen HN, Rønholt F, et al. Comprehensive discharge follow-up in patients' homes by GPs and district nurses of elderly patients: a randomized controlled trial. Scand J Prim Health Care. 2010;28(3):146-153.
28. Koehler BE, Richter KM, Youngblood L, et al. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4(4):211-218.
29. Braun E, Baidusi A, Alroy G, Azzam ZS. Telephone follow-up improves patients satisfaction following hospital discharge. Eur J Intern Med. 2009;20(2):221-225.
30. Courtney M, Edwards H, Chang A, Parker A, Finlayson K, Hamilton K. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. J Am Geriatr Soc. 2009;57(3):395-402.
31. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-187.
32. Wakefield BJ, Ward MM, Holman JE, et al. Evaluation of home telehealth following hospitalization for heart failure: a randomized trial. Telemed J E Health. 2008;14(8):753-761.
33. Balaban RB,Weissman JS, Samuel PA, Woolhandler S. Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study. J Gen Intern Med. 2008;23(8):1228-1233.
34. Wong FK, Chow S, Chung L, et al. Can home visits help reduce hospital readmissions? randomized controlled trial. J Adv Nurs. 2008;62(5):585-595.
35. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822-1828. (Pubitemid 44455163)
36. Linné AB, Liedholm H. Effects of an interactive CD-program on 6 months readmission rate in patients with heart failure - a randomised, controlled trial [NCT00311194]. BMC Cardiovasc Disord. 2006;6:30.
37. Casas A, Troosters T, Garcia-Aymerich J, et al; members of the CHRONIC Project. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J. 2006;28(1):123-130. (Pubitemid 44914269)
38. Riegel B, Carlson B, Glaser D, Romero T. Randomized controlled trial of telephone case management in Hispanics of Mexican origin with heart failure. J Card Fail. 2006;12(3):211-219.
39. Koelling TM, Johnson ML, Cody RJ, Aaronson KD. Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation. 2005;111(2):179-185. (Pubitemid 40139729)
40. Mejhert M, Kahan T, Persson H, Edner M. Limited long term effects of a management programme for heart failure. Heart. 2004;90(9):1010-1015. (Pubitemid 39127915)
41. Kwok T, Lum CM, Chan HS, Ma HM, Lee D, Woo J. A randomized, controlled trial of an intensive community nurse-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease. J Am Geriatr Soc. 2004;52(8):1240-1246. (Pubitemid 39038194)
42. Doughty RN,Wright SP, Pearl A, et al. Randomized, controlled trial of integrated heart failure management: the Auckland Heart Failure Management Study. Eur Heart J. 2002;23(2):139-146. (Pubitemid 35204232)
43. Jaarsma T, Halfens R, Huijer Abu-Saad H, et al. Effects of education and support on self-care and resource utilization in patients with heart failure. Eur Heart J. 1999;20(9):673-682. (Pubitemid 29204353)
44. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281(7):613-620. (Pubitemid 29098061)
45. Stewart S, Pearson S, Luke CG, Horowitz JD. Effects of home-based intervention on unplanned readmissions and out-of-hospital deaths. J Am Geriatr Soc. 1998;46(2):174-180. (Pubitemid 28082656)
46. Dunn RB, Guy PM, Hardman CS, Lewis PA, Vetter NJ. Can a house call by a public health nurse improve the quality of the discharge process for geriatric patients? Clin Perform Qual Health Care. 1995;3(3):151-155.
47. Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333(18):1190-1195.
48. Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive discharge planning for the hospitalized elderly: a randomized clinical trial. Ann Intern Med. 1994;120(12):999-1006. (Pubitemid 24169279)
49. Naylor MD. Comprehensive discharge planning for hospitalized elderly: a pilot study. Nurs Res. 1990;39(3):156-161. (Pubitemid 20171654)
50. Kulshreshtha A, Kvedar JC, Goyal A, Halpern EF,Watson AJ. Use of remote monitoring to improve outcomes in patients with heart failure: a pilot trial. Int J Telemed Appl. 2010;2010:870959.
51. Graumlich JF, Novotny NL, Nace GS, et al. Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial. J Hosp Med. 2009;4(7):11-19.
52. Atienza F, Anguita M, Martinez-Alzamora N, et al PRICE Study Group. Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program. Eur J Heart Fail. 2004;6(5):643-652. (Pubitemid 39070520)
53. Riegel B, Carlson B. Is individual peer support a promising intervention for persons with heart failure? J Cardiovasc Nurs. 2004;19(3):174-183.
54. Stowasser DA, Collins DM, Stowasser M. A randomised controlled trial of medication liaison services-patient outcomes. J Pharm Pract Res. 2002;32(2):133-140. (Pubitemid 35416141)
55. Li H, Powers BA, Melnyk BM, et al. Randomized controlled trial of CARE: an intervention to improve outcomes of hospitalized elders and family caregivers. Res Nurs Health. 2012;35(5):533-549.
56. Shyu YI, Liang J, Wu CC, et al. A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients ith hip fracture in Taiwan. J Am Geriatr Soc. 2005;53(5):811-818. (Pubitemid 41656926)
57. Angermann CE, Störk S, Gelbrich G, et al Competence Network Heart Failure. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail. 2012;5(1):25-35.
58. Naylor D, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial [published correction appears in J Am Geriatr Soc. 2004;52(7):1228]. J Am Geriatr Soc. 2004;52(5):675-684. (Pubitemid 38596483)
59. Strömberg A, Mårtensson J, Fridlund B, Levin LA, Karlsson JE, Dahlström U. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. Eur Heart J. 2003;24(11):1014-1023. (Pubitemid 36712277)
60. Hansen FR, Poulsen H, Sørensen KH. A model of regular geriatric follow-up by home visits to selected patients discharged from a geriatric ward: a randomized controlled trial. Aging (Milano). 1995;7(3):202-206.
61. Maslove DM, Leiter RE, Griesman J, et al. Electronic versus dictated hospital discharge summaries: a randomized controlled trial. J Gen Intern Med. 2009;24(9):995-1001.
62. Forster AJ, Clark HD, Menard A, et al. Effect of a nurse team coordinator on outcomes for hospitalized medicine patients. Am J Med. 2005;118 (10):1148-1153. (Pubitemid 41362614)
63. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Am J Med. 2001;111(9B):26S-30S. (Pubitemid 34085083)
64. Parry C, Min SJ, Chugh A, Chalmers S, Coleman EA. Further application of the care transitions intervention: results of a randomized controlled trial conducted in a fee-for-service setting. Home Health Care Serv Q. 2009;28(2-3):84-99.
65. Hesselink G, Schoonhoven L, Barach P, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157(6):417-428.
66. Payne RA, Abel GA, Guthrie B, Mercer SW. The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study. CMAJ. 2013;185(5):221-228.