Interventions to reduce 30-day rehospitalization: a systematic review

About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high risk-standardized readmission rates will be subject to a Medicare reimbursement penalty. To describe interventions evaluated in studies aimed at reduci...

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Published inAnnals of internal medicine Vol. 155; no. 8; p. 520
Main Authors Hansen, Luke O, Young, Robert S, Hinami, Keiki, Leung, Alicia, Williams, Mark V
Format Journal Article
LanguageEnglish
Published United States 18.10.2011
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Abstract About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high risk-standardized readmission rates will be subject to a Medicare reimbursement penalty. To describe interventions evaluated in studies aimed at reducing rehospitalization within 30 days of discharge. MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched for reports published between January 1975 and January 2011. English-language randomized, controlled trials; cohort studies; or noncontrolled before-after studies of interventions to reduce rehospitalization that reported rehospitalization rates within 30 days. 2 reviewers independently identified candidate articles from the results of the initial search on the basis of title and abstract. Two 2-physician reviewer teams reviewed the full text of candidate articles to identify interventions and assess study quality. 43 articles were identified, and a taxonomy was developed to categorize interventions into 3 domains that encompassed 12 distinct activities. Predischarge interventions included patient education, medication reconciliation, discharge planning, and scheduling of a follow-up appointment before discharge. Postdischarge interventions included follow-up telephone calls, patient-activated hotlines, timely communication with ambulatory providers, timely ambulatory provider follow-up, and postdischarge home visits. Bridging interventions included transition coaches, physician continuity across the inpatient and outpatient setting, and patient-centered discharge instruction. Inadequate description of individual studies' interventions precluded meta-analysis of effects. Many studies identified in the review were single-institution assessments of quality improvement activities rather than those with experimental designs. Several common interventions have not been studied outside of multicomponent "discharge bundles." No single intervention implemented alone was regularly associated with reduced risk for 30-day rehospitalization. None.
AbstractList About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high risk-standardized readmission rates will be subject to a Medicare reimbursement penalty. To describe interventions evaluated in studies aimed at reducing rehospitalization within 30 days of discharge. MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched for reports published between January 1975 and January 2011. English-language randomized, controlled trials; cohort studies; or noncontrolled before-after studies of interventions to reduce rehospitalization that reported rehospitalization rates within 30 days. 2 reviewers independently identified candidate articles from the results of the initial search on the basis of title and abstract. Two 2-physician reviewer teams reviewed the full text of candidate articles to identify interventions and assess study quality. 43 articles were identified, and a taxonomy was developed to categorize interventions into 3 domains that encompassed 12 distinct activities. Predischarge interventions included patient education, medication reconciliation, discharge planning, and scheduling of a follow-up appointment before discharge. Postdischarge interventions included follow-up telephone calls, patient-activated hotlines, timely communication with ambulatory providers, timely ambulatory provider follow-up, and postdischarge home visits. Bridging interventions included transition coaches, physician continuity across the inpatient and outpatient setting, and patient-centered discharge instruction. Inadequate description of individual studies' interventions precluded meta-analysis of effects. Many studies identified in the review were single-institution assessments of quality improvement activities rather than those with experimental designs. Several common interventions have not been studied outside of multicomponent "discharge bundles." No single intervention implemented alone was regularly associated with reduced risk for 30-day rehospitalization. None.
Author Hinami, Keiki
Hansen, Luke O
Williams, Mark V
Leung, Alicia
Young, Robert S
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  givenname: Mark V
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/22007045$$D View this record in MEDLINE/PubMed
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References 22312152 - Ann Intern Med. 2012 Feb 7;156(3):251; author reply 252
22312153 - Ann Intern Med. 2012 Feb 7;156(3):252; author reply 252
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Snippet About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high...
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SubjectTerms Aftercare - standards
Appointments and Schedules
Fee-for-Service Plans - standards
Hotlines
House Calls
Humans
Medicare - standards
Medication Reconciliation
Patient Discharge - standards
Patient Education as Topic
Patient Readmission - standards
Primary Health Care
Randomized Controlled Trials as Topic
Risk Factors
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Title Interventions to reduce 30-day rehospitalization: a systematic review
URI https://www.ncbi.nlm.nih.gov/pubmed/22007045
Volume 155
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