Postdischarge contacts may not significantly affect unplanned healthcare utilization or patient satisfaction

1. In this systematic review and meta-analysis, postdischarge contacts did not significantly affect hospital readmission rates, emergency department use, or unplanned health care use in general within 30 days of discharge compared with usual care.

2. Most included studies did not report a significant effect on patient satisfaction associated with postdischarge contacts.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Patients who have been newly discharged from hospital often engage in further health care use, including readmission and emergency department (ED) visits. Postdischarge contacts (PDCs) involve health care workers getting in touch with discharged patients with the aim of easing transition to home care and reducing readmission rates. Although one previous systematic review suggested PDCs had no effect on readmissions, the quality of the findings was deemed poor. Thus, this updated systematic review sought to investigate how PDCs conducted within 7 days of discharge may affect ED use, readmission, and patient satisfaction. The most common PDC intervention was a single telephone call, and most interventions involved reviewing patients’ medications. Pooled analyses of patients showed that PDCs did not significantly affect hospital readmissions, ED use, or unplanned health care use in general within 30 days of discharge compared with usual care. Although a meta-analysis was not possible for patient satisfaction as each study measured this variable differently, it was found that PDCs generally did not significantly affect patient satisfaction, apart from one small study that showed patients who had undergone PDCs had significantly higher satisfaction. The generalizability of this study was limited by the fact that the included studies had poor descriptions of adherence to interventions, a small sample size, a poor definition of “usual care,” a tendency to omit subgroup analyses, and a lack of consideration of social determinants of health. Moreover, all but one of the studies looked solely at telephone calls. Nonetheless, the results of this study may invite reconsideration of existing universal PDC protocols.

Click to read this study in AIM

Relevant Reading: Nurse-led postdischarge telephone follow-up calls: A mixed study systematic review

In-Depth [systematic review and meta-analysis]: This systematic review and meta-analysis investigated associations between PDCs conducted within 7 days of discharge and unplanned health care use, including hospital readmissions and ED use, within 30 days of discharge. Studies were included if they focused on PDCs between a non-specialist clinical provider and an adult within 7 days of discharge and investigated their association with 30-day hospital readmission, 30-day ED use, or patient satisfaction. The researchers selected 13 studies for this systematic review, with a median sample size of 311 participants. Among the core functions of PDC identified by the researchers, medication review was incorporated into PDCs in 10 studies, coordination of services in 9 studies, and monitoring of patient symptoms in 7 studies. Readmission was investigated in 11 studies, among which 7 randomized trials (RTs) were combined to yield a pooled analysis of 7075 patients. This analysis showed that PDCs did not significantly affect 30-day hospital readmissions (risk difference, 0.00 [95% CI, -0.02 to 0.02]) compared with usual care, findings which were corroborated by a non-randomized trial and an interrupted time-series study. ED use was investigated in 7 studies, among which 5 RTs were combined to yield a pooled analysis of 3054 patients. This analysis showed that PDCs did not significantly affect 30-day ED use (risk difference, 0.00 [95% CI, -0.02 to 0.03]) compared with usual care; the non-randomized trial and interrupted time-series study also did not note a significant effect. The composite of unplanned health care use was investigated in 4 studies, among which 3 RTs were combined to yield a pooled analysis of 1456 patients. This analysis showed that PDC did not significantly affect 30-day unplanned health care use (risk difference, 0.01 [95% CI, -0.09 to 0.10]) compared with usual care. Patient satisfaction was generally high regardless of whether participants had undergone PDC or usual care, although one study (n = 60) showed that PDC participants had a significantly higher patient satisfaction. These results suggested that PDC did not significantly affect outcomes related to unplanned health care use or patient satisfaction.

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