Facilitating safe patient transition of care: A qualitative systematic review

Abstract

Background: Failure to appropriately plan for a safe and effective transition to the next level of care leads to greater use of hospital and emergency services, often measured by rates of readmission. Despite a focus to develop programs to reduce readmissions, the 30-day all-cause readmission rate for Medicare patients in 2011 remained essentially unchanged. Purpose: The objective of this qualitative systematic review was to synthesize the evidence for interventions aimed at reducing readmissions through a transition of care program. Methods: We searched PubMed and Medline (OVID) with search terms including home care services, continuity of patient care, patient discharge, patient-centered care, health planning, and patient readmission. Selection criteria included quantitative studies, qualitative studies, and expert opinion articles in which a transition of care intervention, was implemented. The outcome of interest was readmission rates. Results: Thirty-three articles met inclusion criteria. The data were synthesized into two categories: primary studies in which the readmission rate was measured as an outcome, and studies that systematically reviewed interventions aimed at improving the discharge process. In all studies reviewed, a transitional care intervention resulted in a statistically significant reduction in readmission rate, or a rate trending lower, or the rate remained the same. Several studies evaluating an intervention occurring during and after hospitalization demonstrated significant results. Conclusion: There is value in reconfiguring discharge processes toward interventions that are more likely to reduce readmissions. The discharge process should incorporate a multidisciplinary, multicomponent transition of care intervention that involves hospital and home-care follow-up.