Interventions to Improve Hospital Admission and Discharge Management: An Umbrella Review of Systematic Reviews

Straßner, Cornelia; Hoffmann, Mariell; Forstner, Johanna; Roth, Catharina; Szécsényi, Joachim; Wensing, Michel

doi:10.1097/qmh.0000000000000244

Cited by 16 publications

(22 citation statements)

References 47 publications

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“…Our results are in line with other umbrella reviews investigating interventions to improve hospital admissions and transitional care strategies in adult populations in calling for more robust RCTS that extend beyond the hospital stay and meet the patients’ needs [ 103 , 104 ]. A systematic review investigating the effect of transitional care interventions on hospital readmissions in older medical patients also reported that more RCTs are required that include an intervention with minimum duration of one month and that target high- risk patients [ 105 ].…”

Section: Discussionsupporting

confidence: 86%

The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

et al. 2022

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Background Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults following presentation to the ED. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED. Methods Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and the PROSPERO register up until June 2020. Grey literature was also searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed using a matrix of evidence table. An algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied for all outcomes. Results Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate. Results were presented narratively and summary of evidence tables created. Conclusion Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The existing evidence for the effectiveness of ED interventions for older adults is limited. This umbrella review highlights the challenge of synthesising evidence due to significant heterogeneity in methods, intervention content and reporting of outcomes. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended, rather than the publication of further systematic reviews. Trial registration UMBRELLA REVIEW REGISTRATION: PROSPERO (CRD42020145315).

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Section: Discussionsupporting

confidence: 86%

The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

et al. 2022

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“…However, we encourage a system-level integration of clinical data to bridge the information gap between each transition. The more clinical data available, the more prediction models can be practically useful for efficiency and quality improvement in home care [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Since LTHC patients were usually at older age with multiple comorbidities, it is challenging to balance between investments in a readmission reduction effort and readmission cost for homecare providers [8,9]. Risk management predictive models allow home care providers to arrange the priority of medical interventions according to the patient's hospitalization risk and optimize the utilization of medical resources [10]. However, there remains a gap in putting predictive models into actual practice for home care patients [11].…”

Section: Introductionmentioning

confidence: 99%

“…LACE score is a readmission predictive model for various clinical scenarios including inpatients [12], surgical patients [13], chronic obstructive pulmonary disease (COPD) [14], and heart failure patients [15]. Preventive intervention can be prioritized according to patients' risk [2,10,13,[16][17][18]. Due to its simplicity features, LACE score gained attention among many emerging readmission predictive models [19].…”

Section: Introductionmentioning

confidence: 99%

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LACE Score-Based Risk Management Tool for Long-Term Home Care Patients: A Proof-of-Concept Study in Taiwan

Chen

Huang

et al. 2021

IJERPH

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Background: Effectively predicting and reducing readmission in long-term home care (LTHC) is challenging. We proposed, validated, and evaluated a risk management tool that stratifies LTHC patients by LACE predictive score for readmission risk, which can further help home care providers intervene with individualized preventive plans. Method: A before-and-after study was conducted by a LTHC unit in Taiwan. Patients with acute hospitalization within 30 days after discharge in the unit were enrolled as two cohorts (Pre-Implement cohort in 2017 and Post-Implement cohort in 2019). LACE score performance was evaluated by calibration and discrimination (AUC, area under receiver operator characteristic (ROC) curve). The clinical utility was evaluated by negative predictive value (NPV). Results: There were 48 patients with 87 acute hospitalizations in Pre-Implement cohort, and 132 patients with 179 hospitalizations in Post-Implement cohort. These LTHC patients were of older age, mostly intubated, and had more comorbidities. There was a significant reduction in readmission rate by 44.7% (readmission rate 25.3% vs. 14.0% in both cohorts). Although LACE score predictive model still has room for improvement (AUC = 0.598), it showed the potential as a useful screening tool (NPV, 87.9%; 95% C.I., 74.2–94.8). The reduction effect is more pronounced in infection-related readmission. Conclusion: As real-world evidence, LACE score-based risk management tool significantly reduced readmission by 44.7% in this LTHC unit. Larger scale studies involving multiple homecare units are needed to assess the generalizability of this study.

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“…There is a multitude of studies aiming to improve health care at this interface, yet the evidence is inconclusive. Furthermore, the transition from home to the hospital is not well researched [3][4][5][6]. The VESPEERA programme for hospital admissions and discharges addressed this issue by involving primary care teams in a multifaceted intervention to enhance information transfers across the whole process from admission by the general practice, the hospital stay and discharge up to follow-up care by the general practice.…”

Section: Introductionmentioning

confidence: 99%

How To Fall Into A New Routine: Factors Influencing The Implementation Of An Admission And Discharge Program In Hospitals And General Practices

Forstner

Litke

Weis

et al. 2022

Preprint

Self Cite

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Introduction: The VESPEERA programme is a multifaceted programme to enhance information transfers across the whole process from admission, stay and discharge from the hospital to general practice. It was implemented in 7 hospitals and 72 general practices in Southern Germany. Intervention fidelity was heterogeneous, but overall low. A process evaluation aimed at identifying factors associated with the implementation of the VESPEERA programme.Methods: This was a qualitative study, using semi-structured interviews, in a purposeful sample of health workers in hospitals and general practices in the VESPEERA programme. Qualitative framework analysis using the Consolidated Framework for Implementation Research was performed and revealed the topic of previous and new routines to be protruding. Then, content analysis was used and an inductive set of four stages to describe the process of staying in a previous or falling into a new routine by implementing the VESPEERA programme was developed.Results: Thirty-six interviews were conducted with 17 participants from general practices and 19 participants from hospitals. The interviewees were in different stages of the implementation process at the time of the interviews. The four stages are as following: Stage 1, “Previous routine and tension for change”, describes the initial setting in which VESPEERA was to be implemented and the factors leading to the decision to participate. In stage 2, “Adoption of the VESPEERA programme”, factors that influenced whether individuals decided to employ the innovation is described. Stage 3 comprises ”Determinants for falling into and staying in the new VESPEERA-routine”, and finally, in stage 4, the participants reflect on the success of the implementation. Conclusions: The individuals and organisations participating in the VESPEERA programme were in different stages of a from the previous to the new routine. These stages were characterised by different determinants to implementation. Emerging topics were related to organisational characteristics, such as size of the organisation, hierarchy, and leadership. Developing a new routine was identified as beneficial for implementation the innovation.Trial Registration: DRKS00015183 on DRKS / Universal Trial Number (UTN): U1111-1218-0992

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Interventions to Improve Hospital Admission and Discharge Management: An Umbrella Review of Systematic Reviews

Cited by 16 publications

References 47 publications

The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

LACE Score-Based Risk Management Tool for Long-Term Home Care Patients: A Proof-of-Concept Study in Taiwan

How To Fall Into A New Routine: Factors Influencing The Implementation Of An Admission And Discharge Program In Hospitals And General Practices

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