Effects, barriers and facilitators in predischarge home assessments to improve the transition of care from the inpatient care to home in adult patients: an integrative review

Abstract

Background Predischarge home assessments (PDHA) aim to support safe discharge from hospital or rehabilitation. There is insufficient evidence on the effectiveness of PDHA. For adults with any diagnosis, we aimed to determine (1) the effects of PDHA on outcomes associated with the successful return to community living (e.g., Activities of Daily Living, falls) and (2) the associated barriers and facilitators in order to derive recommendations for clinical practice. Methods We searched Medline, EMBASE, CINAHL, five additional databases and other sources. We included individual and cluster randomized (RCT/cRCT) and controlled clinical trials comparing PDHA versus usual care/other intervention, as well as qualitative/mixed methods studies dealing with PDHA. Critical appraisal was performed according to the Cochrane risk-of-bias tool in quantitative studies and the Critical Appraisal Skills Programme (CASP) as well as the McMaster University Guidelines for Critical Review Form for qualitative studies and data extraction. Meta-analysis, thematic synthesis and integrative synthesis were performed. Results Eight RCTs (n = 1072) and ten qualitative studies (n = 336) met the inclusion criteria. RCTs reported a variety of outcomes (n = 17). We are uncertain if PDHA has any effect on patient outcomes in Activities of Daily Living, quality of life, mobility and fear of falling, falls and hospital readmissions (with moderate to very low quality of the evidence). The qualitative studies revealed facilitators and barriers which should be considered by therapists when conducting PDHA. These were related to the following topics: patient safety education, patient information, patients’ acceptance of modifications and aids, functional assessment, standardization of procedures as well as the consideration of relevant patient conditions and contextual factors in PDHA. Conclusion There is no evidence from the meta-analysis for the effectiveness of PDHA. Further robust studies are needed to adapt and evaluate PDHA interventions, taking the identified stakeholders’ views on PDHA into account and following the current recommendations for the development and evaluation of complex interventions. Trial registration The review was registered and methods were reported on PROSPERO on 18th July 2018 (CRD42018100636).

Differences in Daily Activity Performance Between Inpatient Rehabilitation Facility and Home Among Stroke Survivors

“…Although home visits prior to discharge have been recommended, 30 they are still not standard practice at many IRFs because of lack of time, productivity standards, and limited evidence supporting their effectiveness in improving discharge outcomes. 31 There is currently only low-to-moderate evidence that predischarge home visits improve patient outcomes, [32][33][34] but it is possible that addressing barriers in the environment during home visits could be instrumental in adequately preparing stroke survivors for a successful transition home after stroke and lead to greater independence, fewer falls, and less reliance on caregivers. [35][36][37] However, additional rigorous trials among stroke survivors are needed to examine whether home visits can in fact improve safety, participation, and independence after discharge from an IRF.…”

Discharge Planning Carried Out by Nurses to Increase Caregivers' Competence: A Clinical Trial

“…An initial and ongoing assessment of the dyad is essential for planning and implementing strategies to support clients and their family [22][23] and, thus, promote care continuity. Such moment provides time and support for discharge planning, anticipating conditions that may occur at home, enabling those involved to deal with the functional decline of their family members, in addition to determining the caregiver's psychological readiness to promote active involvement in decision-making and ease the education required for health self-management 12,23 . Secondly, in the home environment, the interventions should be based on experiences and difficulties adapting to the role of caregiver 1 .…”

“…Another aspect that exerted a positive impact on performance of the competencies and which showed statistical significance consists of the caregivers' previous experience with tasks related to care, contrasting with the results found in the pilot study 5 . In general, the existing studies fail to address the caregivers' previous experience with care and are limited to time as a caregiver and to the hours devoted to caregiving 7,13,23,24,25 . These results suggest that, over time and/or because they have already experienced successes and mistakes in daily care, informal caregivers acquired the necessary skills to manage home-based care.…”

Planejamento De Alta Realizado Por Enfermeiros Para O Aumento Da Competência De Cuidadores: Ensaio Clínico

“…A avaliação inicial e contínua da díade é essencial para o planejamento e implementação de estratégias para apoiar o cliente e sua família [22][23] e assim promover a continuidade do cuidado. Tal momento fornece tempo e subsídios para o planejamento da alta, antecipando condições que podem se manifestar no domicílio, capacitando os envolvidos para lidar com o declínio funcional de seus familiares, além de determinar a prontidão psicológica do cuidador para promover o envolvimento ativo na tomada de decisão e facilitar a educação necessária para a autogestão da saúde 12,23 . Em um segundo momento, no ambiente domiciliar, as intervenções devem fundamentar-se nas experiências e dificuldades em se adaptar ao papel de cuidador 1 .…”