Joel M. Schectman, MD, MPH
What is the efficacy of interventions to improve patient transition from hospital discharge to primary care?
Included studies involved patients ≥ 18 years of age and care providers during the transition of care from hospital to primary care or home care; assessed interventions with ≥ 1 component aimed at improving patient handover from hospital to primary care providers (before, during, or after physical transition of patients) within country borders; and reported ≥ 1 quality or safety process measure or outcome of the handovers within 3 months of discharge. Exclusion criteria were psychiatric diagnosis, pregnancy, reporting only health care service expenditures and costs, or quality score ≤ 3 out of 10 (modified Cochrane criteria). Outcomes included patient status; errors, near-misses, or adverse events; hospital use; and continuity of care (see Table footnote for definitions).
PubMed, EMBASE/Excerpta Medica, CINAHL, PsycINFO, Cochrane Library (all to Mar 2011), and reference lists were searched for English-language, randomized, controlled trials (RCTs). 36 RCTs met selection criteria (n = 14 175): 34 assessed multicomponent interventions, and 26 included aspects of case management. Interventions were categorized according to the components of the intervention that aimed to improve patient handovers: 1) quality of information exchanged (completeness, accuracy, and clarity); 2) coordination of care (assessment, planning, and organization of follow-up services and needs); and 3) communication (personal and direct contact, accessibility, and timeliness of information exchange). Mean quality score was 6.8 out of 10. 18 RCTs involved elderly patients.
Meta-analysis was not done because of heterogeneity of study designs, participants, and outcomes. 25 RCTs reported significant effects favoring the intervention in ≥ 1 outcome. Results by components of the intervention that aimed to improve patient handovers are in the Table.
Several interventions to improve the transition of patient care from hospital to primary care may have positive effects on various processes or patient outcomes.
Interventions to improve patient transition from hospital to primary care
*Out of the number of trials assessing the outcome. Interventions could include ≥ 1 component.
†Quality of life, satisfaction, perception of discharge preparedness, self-perceived medication understanding, medication adherence, functional ability, or death.
‡Mismatch in drug name, dose, or frequency prescribed in discharge letter and by primary care provider; medication discrepancies between hospital and community pharmacy records; preventable adverse events; medication prescription error; any medication discrepancy.
§Postdischarge or unplanned rehospitalizations, hospitalizations, emergency department visits; length of hospital stay.
Schectman JM. Review: Interventions for patient transition from hospital to primary care may improve outcomes. Ann Intern Med. ;158:JC12. doi: 10.7326/0003-4819-158-2-201301150-02012
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Published: Ann Intern Med. 2013;158(2):JC12.
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