Study Suggests Postdischarge Care Needs Targeted, Multifaceted Approaches

The findings challenge the effectiveness of these widely used transitional care interventions and suggest a need for more targeted approaches.

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A recent systematic review has found that postdischarge contacts (PDCs), often implemented within 7 days of hospital discharge, do not significantly reduce 30-day emergency department (ED) visits or hospital readmissions compared with standard care.1 The findings challenge the effectiveness of these widely used transitional care interventions and suggest a need for more targeted, multifaceted approaches to address the needs of higher-risk patients, according to the study published in Annals of Internal Medicine.

PDCs, commonly employed as a transitional care strategy, aim to prevent acute care utilization after hospital discharge. Previous research showed that adverse events frequently occurred in the predischarge period, and many could potentially have been prevented or addressed with simple strategies.2
In this investigation, researchers sought to assess the impact of PDCs on 3 critical outcomes: 30-day ED visits, 30-day hospital readmissions, and patient satisfaction.1 The study reviewed randomized and nonrandomized trials published between 2012 and May 2023, sourced from MEDLINE, Embase, and CINAHL databases. Eligible studies implemented PDCs within 7 days of hospital discharge.

A total of 13 studies were included, with 11 being randomized trials (RTs). Most interventions (12 of 13) were delivered via telephone, often as a single contact within 3 days of discharge. In the study selection process, 104 articles were identified, with 13 meeting the eligibility criteria. This included 1 cluster randomized trial, 10 RTs, 1 nonrandomized trial, and 1 interrupted time series. Risk of bias (ROB) was assessed, revealing 3 RTs with low ROB, 1 with high ROB, and serious ROB in both nonrandomized studies. Geographically, 6 studies were from the US, 5 from Europe, 1 from New Zealand, and 1 from Canada. Eight studies focused on high-risk patients, and the median sample size was 311, ranging from 25 to 3054 patients.

An analysis of 5 randomized trials involving 3054 patients found no significant reduction in ED visits within 30 days, with a risk difference of 0.00 (95% CI, -0.02 to 0.03), indicating moderate certainty in the results. Additionally, a review of 7 randomized trials that included 7075 patients showed no observed difference in hospital readmission rates, also with a risk difference of 0.00 (95% CI, -0.02 to 0.02) and moderate certainty. The study noted that patient satisfaction was not consistently reported across the studies examined.

Overall, the evaluation showed consistent results across both nonrandomized studies and subgroup analyses. Additionally, 4 studies assessed unplanned health care use by measuring composite outcomes, including hospital readmissions and ED visits, and found no significant differences between intervention and control groups. Finally, patient satisfaction was evaluated in 4 studies involving 3397 patients, revealing overall high satisfaction levels; however, only 1 small study (n = 60) indicated significantly higher satisfaction within the PDC group.

The researchers identified several limitations, including poor documentation of adherence and fidelity to PDC protocols and a lack of exploration of non-telephone PDC methods. Additionally, only a subset of interventions targeted higher-risk patients, and the certainty of evidence varied.

The findings suggest that universal PDCs may not effectively reduce acute care utilization within 30 days of discharge. The authors recommended reevaluating the blanket implementation of PDCs, particularly for lower-risk patients. Instead, they highlight the potential value of multifaceted interventions tailored to higher-risk populations, which may address underlying needs more effectively.

"The promise of these structures is to encourage seamless transfers of information and care responsibilities to outpatient clinicians while potentially avoiding costly subsequent health care use in acute care settings," the researchers wrote. "Despite the wide deployment of PDC strategies, many unanswered questions remain about their effect on key health care outcomes."

References

1. Boggan JC, Sankineni S, Dennis PA, et al. Effectiveness of synchronous postdischarge contacts on health care use and patient satisfaction: a systematic review and meta-analysis. Ann Intern Med. Published online January 14, 2025. doi:10.7326/ANNALS-24-01140

2. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161-167. doi:10.7326/0003-4819-138-3-200302040-00007