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Improving Patient Handovers From Hospital to Primary Care: A Systematic Review

Gijs Hesselink, MA, MSc; Lisette Schoonhoven, RN, PhD; Paul Barach, MD, MPH; Anouk Spijker, MA; Petra Gademan, MD; Cor Kalkman, MD, PhD; Janine Liefers, MSc; Myrra Vernooij-Dassen, PhD; and Hub Wollersheim, MD, PhD
[+] Article and Author Information

From Radboud University Nijmegen Medical Centre, Nijmegen, and University Medical Center Utrecht, Utrecht, the Netherlands.

Acknowledgment: The authors thank Reinier Akkermans, MSc, for methodological and statistical assistance.

Grant Support: By the European Union, the Framework Programme of the European Commission (FP7-HEALTH-F2-2008-223409).

Potential Conflicts of Interest: Mr. Hesselink: Grant (money to institution): European Union, the Framework Programme of the European Health Commission; Support for travel to meetings for the study or other purposes: European Union, the Framework Programme of the European Health Commission. Dr. Schoonhoven: Grant (money to institution): European Union, the Framework Programme of the European Health Commission. Dr. Barach: Grant (money to institution): European Union, the Framework Programme of the European Health Commission; Support for travel to meetings for the study or other purposes: European Union, the Framework Programme of the European Health Commission. Dr. Gademan: Grant (money to institution): European Union, the Framework Programme of the European Health Commission. Dr. Kalkman: Grant (money to institution): European Union; Support for travel to meetings for the study or other purposes: European Union. Dr. Vernooij-Dassen: Grant (money to institution): European Union; Support for travel to meetings for the study or other purposes: European Union; Employment: Radboud University Nijmegen; Grants/grants pending (money to institution): European Union. Dr. Wollersheim: Grant (money to institution): European Union, the Framework Programme of the European Health Commission; Support for travel to meetings for the study or other purposes: European Union, the Framework Programme of the European Health Commission. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2696.

Requests for Single Reprints: Gijs Hesselink, MA, MSc, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, PO Box 9101, IQ 114, 6500 HB Nijmegen, the Netherlands; e-mail, g.hesselink@iq.umcn.nl.

Current Author Addresses: Mr. Hesselink; Ms. Spijker and Ms. Liefers; and Drs. Schoonhoven, Vernooij-Dassen, and Wollersheim: Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, PO Box 9101, IQ 114, 6500 HB Nijmegen, the Netherlands.

Drs. Barach, Gademan, and Kalkman: UMC Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.

Author Contributions: Conception and design: G. Hesselink, L. Schoonhoven, P. Barach, A. Spijker, P. Gademan, M. Vernooij-Dassen, H. Wollersheim.

Analysis and interpretation of the data: G. Hesselink, L. Schoonhoven, P. Gademan, J. Liefers, M. Vernooij-Dassen, H. Wollersheim.

Drafting of the article: G. Hesselink, L. Schoonhoven, P. Barach, M. Vernooij-Dassen, H. Wollersheim.

Critical revision of the article for important intellectual content: L. Schoonhoven, P. Barach, A. Spijker, C. Kalkman, M. Vernooij-Dassen, H. Wollersheim.

Final approval of the article: G. Hesselink, L. Schoonhoven, P. Barach, A. Spijker, P. Gademan, C. Kalkman, J. Liefers, M. Vernooij-Dassen, H. Wollersheim.

Statistical expertise: M. Vernooij-Dassen.

Obtaining of funding: P. Barach, H. Wollersheim.

Administrative, technical, or logistic support: J. Liefers, H. Wollersheim.

Collection and assembly of data: G. Hesselink, A. Spijker, P. Gademan, J. Liefers, H. Wollersheim.


Ann Intern Med. 2012;157(6):417-428. doi:10.7326/0003-4819-157-6-201209180-00006
Text Size: A A A

Background: Evidence shows that suboptimum handovers at hospital discharge lead to increased rehospitalizations and decreased quality of health care.

Purpose: To systematically review interventions that aim to improve patient discharge from hospital to primary care.

Data Sources: PubMed, CINAHL, PsycInfo, the Cochrane Library, and EMBASE were searched for studies published between January 1990 and March 2011.

Study Selection: Randomized, controlled trials of interventions that aimed to improve handovers between hospital and primary care providers at hospital discharge.

Data Extraction: Two reviewers independently abstracted data on study objectives, setting and design, intervention characteristics, and outcomes. Studies were categorized according to methodological quality, sample size, intervention characteristics, outcome, statistical significance, and direction of effects.

Data Synthesis: Of the 36 included studies, 25 (69.4%) had statistically significant effects in favor of the intervention group and 34 (94.4%) described multicomponent interventions. Effective interventions included medication reconciliation; electronic tools to facilitate quick, clear, and structured summary generation; discharge planning; shared involvement in follow-up by hospital and community care providers; use of electronic discharge notifications; and Web-based access to discharge information for general practitioners. Statistically significant effects were mostly found in reducing hospital use (for example, rehospitalizations), improvement of continuity of care (for example, accurate discharge information), and improvement of patient status after discharge (for example, satisfaction).

Limitations: Heterogeneity of the interventions and study characteristics made meta-analysis impossible. Most studies had diffuse aims and poor descriptions of the specific intervention components.

Conclusion: Many interventions have positive effects on patient care. However, given the complexity of interventions and outcome measures, the literature does not permit firm conclusions about which interventions have these effects.

Primary Funding Source: The European Union, the Framework Programme of the European Commission.

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Summary of evidence search and selection.

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Comments

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Hospital to Primary Care Handover
Posted on September 20, 2012
Andrea Ries MD
Medical Associates Clinic, Dubuque, Iowa, USA
Conflict of Interest: None Declared
Our practice and local hospital have struggled with hospital readmissions, handoff failures. I read this issue with hope that some great idea has made the difference. Communication breakdown between hospital based and primary outpatient care providers seems to be an ongoing concern. Is the data any different for those providers who choose to care for their own inpatients? I maintain that those physicians have a better long term relationship and social knowledge of patients.
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