Interventions at hospital discharge may improve transitions to primary care, but more research is needed

Certain interventions at hospital discharge appear to help improve handoffs to primary care, but more research is needed to determine how and why, a new study indicates.

Researchers performed a systematic review of randomized, controlled trials published from January 1990 to March 2011 to examine interventions intended to improve the transition between hospital discharge and primary care. All trials involved transitions from the hospital to primary care or to home and were restricted to adult patients (excluding pregnant women) without a psychiatric diagnosis. Data were extracted on study objectives, setting and design, intervention, and outcomes, and studies were categorized by quality, sample size, intervention characteristics, outcome, direction of effects and statistical significance. Results were published in the Sept. 18 Annals of Internal Medicine.

A total of 36 studies were included in the review. Of these, 25 (69.4%) showed a statistically significant effect favoring the intervention and 34 (94.4%) involved multicomponent interventions. Medication reconciliation, electronic generation of discharge summaries, discharge planning, shared follow-up between hospital- and community-based clinicians, electronic discharge notifications, and Web-accessible discharge summaries for primary care clinicians were found to be effective. Effective interventions had statistically significant effects on reducing hospital use (e.g., rehospitalizations or emergency department visits), improving care continuity (e.g., medication reconciliation or completeness of discharge summary) and improving patient status (e.g., quality of life or satisfaction) after discharge.

The authors were not able to perform a meta-analysis of the data because of the substantial heterogeneity in the interventions and study characteristics. In addition, most of the included studies had different goals and did not include thorough descriptions of each intervention component. Therefore, the authors concluded that although many interventions at hospital discharge appear to positively impact the transition to primary care, the available data do not allow them to draw firm conclusions about which interventions are most helpful.

“Our review … outlines a rich area for several key research questions, including developing a clearer description of the interventions, using uniform and valid outcome measures, and attending to the care provider's attitudes and training in developing effective handover interventions,” they wrote.