Benefits of Comprehensive Inpatient Education and Discharge Planning Combined With Outpatient Support in Elderly Patients With Congestive Heart Failure

Anderson, Cheryl; Deepak, Borde; Amoateng-Adjepong, Yaw; Zarich, Stuart

doi:10.1111/j.1527-5299.2005.04458.x

Cited by 108 publications

(104 citation statements)

References 33 publications

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“…54 Similar results were noted in more recent trials evaluating comprehensive discharge planning and immediate outpatient reinforcement in heart-failure patients. Anderson et al report a decrease in 6-month readmissions from 44 to 11% (P = 0.01), 55 whereas Naylor et al reported a decrease in 12-month readmissions from 55 to 45% (P = 0.12), which translated to a significant decrease (P = 0.047) in the total number of readmissions. 56 One trial involving 122 patients discharged from a community hospital assessed the effects of an intervention comprising a comprehensive discharge form electronically transferred to the primary care practitioner (listing discharge diagnosis, dietary and activity instructions, home services, scheduled appointments, pending investigations, discharge medications, postdischarge follow-up and recommendations, nursing comments and patient reminders), telephone contact by a primary care nurse after discharge, and a scheduled clinic review.…”

Section: Studies Of Integrated Pre-and Postdischarge Multicomponent Imentioning

confidence: 91%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

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Background. Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions.Objective. To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre-and postdischarge elements.Design. Systematic metareview of controlled trials. Data collection. Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions.Data synthesis. Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure.Conclusion. Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre-and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospitalcommunity interface.What is known about this topic? Unplanned readmissions within 30 days of hospital discharge are common and may reflect deficiencies in discharge processes. Various peridischarge interventions have been evaluated, mostly single-component interventions that occur either before or after discharge, but failing to yield consistent evidence of benefit in reducing readmissions. More recent trials have assessed multicomponent interventions which involve pre-and postdischarge periods, but no formal review of such studies has been undertaken. What does this paper add? With the exception of intense self-management and transition coaching of high-risk patients, and nurse home visits and telephonic support for patients with heart failure, single-component interventions were ineffective in reducing readmissions. Multicomponent interventions demonstrated evidence of benefit in reducing readmissions by as much as 28%, with best results achieved in populations of older patients and those with heart failure. What are the implications for practitioners and managers? Hospital clinicians and managers should critically review and, where appropriate, modify their current discharge processes in accordance with these findings and negotiate the extra funding and personnel required to allow succ...

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Section: Studies Of Integrated Pre-and Postdischarge Multicomponent Imentioning

confidence: 91%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

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“…Of 13 studies reviewed in Table 3, 7 studies were RCTs with sample sizes of 192 to 750 participants, 18,20,21,23,27,45,55 rehospitalization was a primary end point in 10 reports, [18][19][20]23,32,45,53,54,56,57 and rehospitalization was measured at multiple time points, from 30 days to 1 year after the index discharge. In 6 quasiexperimental designs, postintervention and preintervention rehospitalization rates were compared, or intervention groups were compared with concurrent control subjects, and sample sizes ranged from 126 to 1393 participants.…”

Section: Rehospitalizationmentioning

confidence: 99%

Transitions of Care in Heart Failure

Albert¹,

Barnason²,

Deswal³

et al. 2015

Circ: Heart Failure

219

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In patients with heart failure (HF), use of 30-day rehospitalization as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach. Transition programs are being used to achieve goals. Transition of care in the context of HF management refers to individual interventions and programs with multiple activities that are designed to improve shifts or transitions from one setting to the next, most often from hospital to home. As transitional care programs become the new normal for patients with chronic HF, it is important to understand the current state of the science of transitional care, as discussed in the available research literature. Of transitional care reports, there was much heterogeneity in research designs, methods, study aims, and program targets, or they were not well described. Often, programs used bundled interventions, making it difficult to discuss the efficiency and effectiveness of specific interventions. Thus, further HF transition care research is needed to ensure best practices related to economically and clinically effective and feasible transition interventions that can be broadly applicable. This statement provides an overview of the complexity of HF management and includes patient, hospital, and healthcare provider barriers to understanding end points that best reflect clinical benefits and to achieving optimal clinical outcomes. The statement describes transitional care interventions and outcomes and discusses implications and recommendations for research and clinical practice to enhance patient-centered outcomes.

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“…[1][2][3] Multiple exacerbations of CHF result in frequent use of acute health care services by these patients, known as revolving door users. After discharge, 25% of patients are readmitted within the first 30 days, 4,5 and 50% within the first 6 months. 6,7 This frequent use of health care services is mainly due to lack of understanding of a treatment plan, nonadherence to medical therapy, unawareness of CHF symptom exacerbation, and irregular follow-up.…”

mentioning

confidence: 99%

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

Vedel

Khanassov

2015

The Annals of Family Medicine

104

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PURPOSE We aimed to determine the impact of transitional care interventions (TCIs) on acute health service use by patients with congestive heart failure in primary care and to identify the most effective TCIs and their optimal duration. METHODSWe conducted a systematic review and meta-analysis of randomized controlled trials, searching the Medline, PsycInfo, EMBASE, and Cochrane Library databases. We performed a meta-analysis to assess the impact of TCI on all-cause hospital readmissions and emergency department (ED) visits. We developed a taxonomy of TCIs based on intensity and assessed the methodologic quality of the trials. We calculated the relative risk (RR) and a 95% confidence interval for each outcome. We conducted a stratified analysis to identify the most effective TCIs and their optimal duration. RESULTSWe identified 41 randomized controlled trials. TCIs significantly reduced risks of readmission and ED visits by 8% and 29%, respectively (relative risk = 0.92; 95% CI, 0.87-0.98; P = .006 and relative risk = 0.71; 95% CI, 0.51-0.98; P = .04). High-intensity TCIs (combining home visits with telephone followup, clinic visits, or both) reduced readmission risk regardless of the duration of follow-up. Moderate-intensity TCIs were efficacious if implemented for a longer duration (at least 6 months). In contrast, low-intensity TCIs, entailing only followup in outpatient clinics or telephone follow-up, were not efficacious. CONCLUSIONS Clinicians and managers who implement TCIs in primary carecan incorporate these results with their own health care context to determine the optimal balance between intensity and duration of TCIs. High-intensity interventions seem to be the best option. Moderate-intensity interventions implemented for 6 months or longer may be another option. INTRODUCTIONC ongestive heart failure (CHF) imposes an increasingly heavy burden on health care systems, most of which can be attributed to numerous hospital readmissions and emergency department (ED) visits. [1][2][3] Multiple exacerbations of CHF result in frequent use of acute health care services by these patients, known as revolving door users. After discharge, 25% of patients are readmitted within the first 30 days, 4,5 and 50% within the first 6 months. 6,7 This frequent use of health care services is mainly due to lack of understanding of a treatment plan, nonadherence to medical therapy, unawareness of CHF symptom exacerbation, and irregular follow-up. [8][9][10][11][12] Lack of coordination and communication between hospitalists and primary care physicians (PCPs) has been documented. 13,14 PCPs too often do not receive discharge summaries, 15 and when they do receive them, the summaries often lack appropriate documentation of medication indication and advice for follow-up. It is therefore difficult for PCPs to plan an appropriate follow-up after hospital discharge. 16To address these issues, transitional care interventions (TCIs) have been implemented with a common objective of reducing the rate of hos- 563pital readmis...

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Benefits of Comprehensive Inpatient Education and Discharge Planning Combined With Outpatient Support in Elderly Patients With Congestive Heart Failure

Cited by 108 publications

References 33 publications

Preventing the rebound: improving care transition in hospital discharge processes

Preventing the rebound: improving care transition in hospital discharge processes

Transitions of Care in Heart Failure

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

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