BACKGROUND: Postdischarge contacts (PDCs) after hospitalization are common practice, but their effectiveness in reducing use of acute care after discharge remains unclear.
PURPOSE: To assess the effects of PDC on 30-day emergency department (ED) visits, 30-day hospital readmissions, and patient satisfaction.
DATA SOURCES: MEDLINE, Embase, and CINAHL searched from 2012 to 25 May 2023.
STUDY SELECTION: Randomized and nonrandomized trials of PDC within 7 days.
DATA EXTRACTION: Two investigators independently screened articles and assessed risk of bias (ROB). Single reviewers extracted data, with verification by second investigators. Random-effects meta-analyses were done on outcomes shared by at least 3 studies, and the certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.
DATA SYNTHESIS: Of 13 included studies (11 randomized trials [RTs]), 12 delivered PDCs via telephone. Three of 11 RTs were rated as having low ROB, with 1 rated high. Most PDC interventions (n = 10) consisted of single telephone contacts, often within 3 days. Eight studies focused on patients identified as higher-risk by the authors. There were no differences in 30-day ED use (5 RTs; 3054 patients; risk difference, 0.00 [95% CI, -0.02 to 0.03]; moderate certainty) or 30-day hospital readmissions (7 RTs; 7075 patients; risk difference, 0.00 [CI, -0.02 to 0.02]; moderate certainty) with PDC.
LIMITATION: Adherence and fidelity to PDC interventions were poorly described, and only 1 study investigated nontelephone PDC.
CONCLUSION: Postdischarge contacts within 7 days of discharge were not associated with reductions in 30-day ED use or readmissions compared with usual care. Health systems should reconsider the utility of universal PDCs because multifaceted interventions targeting higher-risk patients may be necessary to reduce use of acute care after discharge.
PRIMARY FUNDING SOURCE: Department of Veterans Affairs. (PROSPERO: CRD42023465675).
| Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Family Medicine (FM)/General Practice (GP) | |
| General Internal Medicine-Primary Care(US) |
As a primary care provider, I see this go on all the time. Often the nursing staff who contacts the patient after hospital discharge has no understanding of why the patient was hospitalized or how that affected their future care. There is some "measurement" in out-patient clinics that these contacts must be made, but I agree that they are ineffective for the most part. As a former hospitalist and now an out-patient physician, the disconnect is greater than ever.
Surprising results.
Excellent practical topic and has budget allocation relevance.
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