Optimizing emergency department care transitions to outpatient settings: A systematic review and meta-analysis

Aghajafari, Fariba; Sayed, Sayeeda Amber; Emami, Nader; Lang, Eddy; Abraham, Joanna

doi:10.1016/j.ajem.2020.07.043

Cited by 12 publications

(22 citation statements)

References 63 publications

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“…Of the nonrandomized studies reviewed, only two showed significant effects (with one demonstrating decreased odds and one increased odds). This parallels other reviews, which found mostly nonsignificant or increased associations between these ED‐based interventions and 30‐day revists 14,20 …”

Section: Discussionsupporting

confidence: 86%

“…Examined as a quality indicator, ED revisits are commonly measured at 30 days after discharge with additional time frames used to obtain a more nuanced understanding of processes influencing revisits 20,29 . We included all unplanned ED use, regardless of reason, during the 30 days after discharge as abstracted from electronic medical records (with out‐of‐system ED use identified during participant phone surveys).…”

Section: Methodsmentioning

confidence: 99%

“…Improving ED‐to‐home care transitions has been promoted as a strategy to prevent revisits and improve health and cost outcomes for older ED patients 12,16‐19 . Suboptimal transitions result in poor continuity of care, fragmentation of services, and increased costs 17,19,20 . Facilitating the ED‐to‐home transition may improve use of outpatient services and adherence to treatment plans.…”

Section: Introductionmentioning

confidence: 99%

“…Facilitating the ED‐to‐home transition may improve use of outpatient services and adherence to treatment plans. Interventions have taken many forms, including improved information provision during discharge, postdischarge telephone follow‐up, outpatient appointment scheduling, processes to improve communication with primary care providers, and providing care coordination/management services 16,20 . Research testing the effectiveness of these interventions has frequently focused on ED revisits as the primary outcome, yielding mixed results with limited generalizability 12,14,16,21,22 …”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Jacobsohn

Jones

Green

et al. 2021

Academic Emergency Medicine

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Background Improving care transitions following emergency department (ED) visits may reduce post‐ED adverse events among older adults (e.g., ED revisits, decreased function). The Care Transitions Intervention (CTI) improves hospital‐to‐home transitions; however, its effectiveness at improving post‐ED outcomes is unknown. We tested the effectiveness of the CTI with community‐dwelling older adult ED patients, hypothesizing that it would reduce revisits and increase performance of self‐management behaviors during the 30 days following discharge. Methods We conducted a randomized controlled trial among patients age ≥ 60 discharged home from one of three EDs in two states. Intervention participants received a minimally modified CTI, with a home visit 24 to 72 h postdischarge and one to three phone calls over 28 days. We collected demographic, health status, and psychosocial data at the initial ED visit. Medication adherence and knowledge of red flag symptoms were assessed via phone survey. Care use and comorbidities were abstracted from medical records. We performed multivariate regressions for intention‐to‐treat and per‐protocol (PP) analyses. Results Participant characteristics (N = 1,756) were similar across groups: mean age 72.4 ± 8.6 years and 53% female. Of those randomized to the intervention, 84% completed the home visit. Overall, 12.4% of participants returned to the ED within 30 days. The CTI did not significantly affect odds of 30‐day ED revisits (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.72 to 1.30) or medication adherence (AOR = 0.89, 95% CI = 0.60 to 1.32). Participants receiving the CTI (PP) had increased odds of in‐person follow‐up with outpatient clinicians during the week following discharge (AOR = 1.24, 95% CI = 1.01 to 1.51) and recalling at least one red flag from ED discharge instructions (AOR = 1.34 95% CI = 1.05 to 1.71). Conclusions The CTI did not reduce 30‐day ED revisits but did significantly increase key care transition behaviors (outpatient follow‐up, red flag knowledge). Additional research is needed to explore if patients with different conditions benefit more from the CTI and whether decreasing ED revisits is the most appropriate outcome for all older adults.

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Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

Jacobsohn

Jones

Green

et al. 2021

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…With older adults particularly susceptible to certain social risk factors, our work builds upon a recent systematic review of all adult ED patients that failed to demonstrate a reduction in repeat ED visits or hospital admission after care transition interventions. 75 Our work robustly assesses interventions from a wide number of international studies, allowing translational components to be considered from countries that have been noted to place a greater emphasis on social services. 76 This analysis also uniquely focuses on social needs and includes all possible care transition interventions, as opposed to reviews 46,48,55,56 previously focused solely on the impact of one intervention or assessment type.…”

Section: Discussionmentioning

confidence: 99%