A Pilot Randomized Control Trial

Hanrahan, Nancy P.; Solomon, Phyllis; Hurford, Matthew O.

doi:10.1177/1078390314552190

Cited by 25 publications

(34 citation statements)

References 28 publications

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“…Predischarge interventions included components from case management, such as needs assessments (28,29,32,34,35,(40)(41)(42)(43), discharge or care planning (e.g., crisis planning) (28,31,35), scheduling or preparing for follow-up appointments (39,42), and family or carer involvement (28,44); psychoeducational components, such as individualized psychoeducation (33) and medication reconciliation elements (29,44); and elements of CBT, such as skills training (29,40,41,44) and peer support (38,43). Interventions were delivered in one-to-one sessions, except for the study conducted by Khaleghparast et al (41), where a family member was present and in Noda et al (44), where skills training was delivered in groups.…”

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

“…Postdischarge components aimed to support patients during a transition period and were most frequently delivered through phone calls, home visits, or letters. Components associated with case management included: efforts to ensure timely follow-up with outpatient care providers (28,32,34,39,42), treatment coordination (28,31,39), timely communication between inpatient staff and outpatient care or community service provider after discharge (29,34), monitoring of health status or implementation of postdischarge plan (31,33,35), and activation of resources in the social network (32). Elements of CBT consisted of therapeutic meetings with staff (30, 37) and skills training (33,40,41,44).…”

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

“…Elements of CBT consisted of therapeutic meetings with staff (30, 37) and skills training (33,40,41,44). In addition, interventions included psychoeducation and counseling (31) or peer support (30,37,38,43). Peer support consisted of facilitating access to local communities, promoting friendship, providing basic necessities, understanding, and encouragement.…”

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

“…Interventions lasted between 1 week (40) and 2 years (33), or until a therapeutic relationship was established between the patient and outpatient care provider (30,37); however, the majority of the interventions ended 3 months after discharge (29,31,32,35,39,41).…”

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

“…Control groups received treatment as usual, which included aftercare or treatment planning (39,40), referral to outpatient treatment (28,29,33,37,39), arrangements from community mental health services (38), and case and medication management (31). Treatment as usual in the study by Puschner et al (35) was delivered without a manualized or structured discharge plan.…”

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

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Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

et al. 2020

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Background: The transition from psychiatric hospital to community is often hindered by challenges that influence community adjustment and continuity of care. Transitional interventions with bridging components are provided prior to discharge and continue beyond inpatient care. They provide continuity of care and may be effective in preventing readmission. We aimed to assess the effectiveness of transitional interventions with predischarge and postdischarge components in reducing readmissions and improving health-related or social outcomes of patients discharged from psychiatric hospitals. Methods:We conducted a systematic review by searching electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Psyndex) and included randomized, nonrandomized, and one-group study designs. A random effects metaanalysis was conducted with randomized controlled trials (RCTs) reporting data on readmission rates. Other study designs were synthesized qualitatively.Results: After screening 2,673 publications, 16 studies (10 RCTs, three quasiexperimental, and three cohort studies) were included and nine RCTs were included in the meta-analysis. The tested interventions included components from case management, psychoeducation, cognitive behavioral therapy, and peer support. All studies with significant improvements in at least one outcome provided elements of case management, most frequently in combination with cognitive behavioral therapy and psychoeducation. Readmission rates during follow-up ranged between 13% and 63% in intervention groups and 19% and 69% in control groups. Overall, we found an odds ratio of 0.76 (95% confidence interval = 0.55-1.05) for readmission due to transitional Frontiers in Psychiatry | www.frontiersin.org January 2020 | Volume 10 | Article 969 1

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Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

Section: Description and Classification Of Intervention Componentsmentioning

confidence: 99%

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Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

et al. 2020

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Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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ImportanceDischarge from the hospital to the community has been associated with serious patient risks and excess service costs.ObjectiveTo evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community.Data SourcesCENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022.Study SelectionRandomized clinical trials evaluating transitional care interventions from hospitals to the community were identified.Data Extraction and SynthesisAt least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Main Outcomes and MeasuresThe primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake.ResultsOverall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, −0.20; 95% CI, −0.38 to −0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits.Conclusions and RelevanceThese findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

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