Discharge Planning Interventions Research Articles

The Social, Demographic, and Clinical Predictors of COVID-19 Severity: a Model-based Analysis of United States Veterans.

This study aims to identify the contributions of individual and community social determinants of health (SDOH), demographic, and clinical factors in COVID-19 disease severity through a model-based analysis. This national cross-sectional study focused on hospitalization among those tested for COVID-19 and use of intensive care, analyzing data on 220,848 Veterans tested between February 20, 2020 and October 20, 2021. Multiple logistic regression models were constructed using backwards elimination. The predictive value of each model was assessed with a c-statistic. Those hospitalized were older, more likely to be male, of Black or Asian race, have an income less than $39,999, live in an urban residence, and have medical comorbidities. The strongest predictors for hospitalization included Gini inequality index, race, income, heart failure, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). For intensive care, Asian race, rural residence, COPD, and CKD were the strongest predictors. C-statistics were c = 0.749 for hospitalization and c = 0.582 for ICU admission. A combination of clinical, demographic, individual and community SDOH factors predict COVID-19 hospitalization with good predictive ability and can inform risk stratification, discharge planning, and public health interventions. Racial disparities were not explained by social or clinical factors. Intensive care models had low discriminative power and may be better explained by other characteristics.

Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care

ObjectivesWe conducted a pilot randomized controlled trial (RCT) to explore whether a hospital inpatient addiction consult team (Substance Use Treatment and Recovery Team [START]) based on collaborative care was feasible, acceptable to patients, and whether it could improve uptake of medication in the hospital and linkage to care after discharge, as well as reduce substance use and hospital readmission. The START consisted of an addiction medicine specialist and care manager who implemented a motivational and discharge planning intervention. MethodsWe randomized inpatients age ≥ 18 with a probable alcohol or opioid use disorder to receive START or usual care. We assessed feasibility and acceptability of START and the RCT, and we conducted an intent-to-treat analysis on data from the electronic medical record and patient interviews at baseline and 1-month postdischarge. The study compared RCT outcomes (medication for alcohol or opioid use disorder, linkage to follow-up care after discharge, substance use, hospital readmission) between arms by fitting logistic and linear regression models. FindingsOf 38 START patients, 97 % met with the addiction medicine specialist and care manager; 89 % received ≥8 of 10 intervention components. All patients receiving START found it to be somewhat or very acceptable. START patients had higher odds of initiating medication during the inpatient stay (OR 6.26, 95 % CI = 2.38–16.48, p < .001) and being linked to follow-up care (OR 5.76, 95 % CI = 1.86–17.86, p < .01) compared to usual care patients (N = 50). The study found no significant differences between groups in drinking or opioid use; patients in both groups reported using fewer substances at the 1-month follow-up. ConclusionsPilot data suggest START and RCT implementation are feasible and acceptable and that START may facilitate medication initiation and linkage to follow-up for inpatients with an alcohol or opioid use disorder. A larger trial should assess effectiveness, covariates, and moderators of intervention effects.

Overview of Discharge Plan Strategies in Rural and Remote Areas: A Narrative Literature Review

Discharge planning is a systematic process that includes assessment, preparation, and coordination and involves various disciplines to provide optimal service. In Indonesia, there are 62 underdeveloped areas that have limitations in health services. Discharge planning in remote areas requires adaptation to be accepted in the community. This review aims to find an effective patient discharge strategy to be implemented in rural areas. Telepharmaceuticals and telerobots act as discharge planning interventions in remote areas. Remote monitoring, such as a pharmacological intervention in late life (PILL) program that focuses on monitoring the treatment of patients with polypharmacy. Interprofessional education and collaborative practice (IPECP) is suitable to be carried out in remote areas where limited facilities stimulate health workers to collaborate. Patient activation measure (PAM) to assess the ability and engagement of patients in maintaining their health. In addition, interventions were found in the form of making patient-centered guidelines in the form of ROADMAP (rural options at discharge - model of active planning).

Effectiveness of Nursing Discharge Planning Interventions for Stroke Patient: A Systematic Review

Inadequate discharge planning for stroke patients poses significant challenges for healthcare. Effective discharge planning interventions have been examined in several studies, but little information is available about nursing roles or specific components of these interventions. It aims to explain the effectiveness of nursing planning interventions for stroke patients. This study was conducted through a systematic review with the PRISMA approach. We obtained 28 articles, and 15 were considered relevant. To analyze the methodological quality in each study, JBI was used for this type of experimental study. Based on a review of 15 articles, it was found that family empowerment-based discharge planning was proven to be effective in improving quality of life, self-care independence, exercise-based discharge planning to be effective in self-care independence, and discharge planning based on home visits and ADL training to be effective in improving self-care independence and mobility.

Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis

BackgroundOlder adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes.MethodsNine indexed databases were searched to identify scientific papers and grey literature on discharge planning interventions for older adults (65+) hospitalized following a fall. Manual searches were also conducted. Documents were selected based on relevance and rigor. Two reviewers extracted and compiled data regarding intervention components, contextual factors, underlying mechanisms and positive outcomes. Preliminary theories were then formulated based on an iterative synthesis process.ResultsTwenty-one documents were included in the synthesis. Four Intervention-Context-Mechanism-Outcome configurations were developed as preliminary theories, based on the following intervention components: 1) Increase two-way communication between healthcare providers and patients/caregivers using a family-centered approach; 2) Foster interprofessional communication within and across healthcare settings through both standardized and unofficial information exchange; 3) Provide patients/caregivers with individually tailored fall prevention education; and 4) Designate a coordinator to manage discharge planning. These components should be implemented from patient admission to return home and be supported at the organizational level (contexts) to trigger knowledge, understanding and trust of patients/caregivers, adjusted expectations, reduced family stress, and sustained engagement of families and professionals (mechanisms). These optimal conditions improve patient satisfaction, recovery, functional status and continuity of care, and reduce hospital readmissions and fall risk (outcomes).ConclusionsSince transitions are critical points with potential communication gaps, coordinated interventions are vital to support a safe return home for older adults hospitalized following a fall. Considering the organizational challenges, simple tools such as pictograms and drawings, combined with computer-based communication channels, may optimize discharge interventions based on frail patients’ needs, habits and values.Empirically testing our preliminary theories will help to develop effective interventions throughout the continuum of transitional care to enhance patients’ health and reduce the economic burden of avoidable care.

A Machine Learning Approach to Predicting Readmission or Mortality in Patients Hospitalized for Stroke or Transient Ischemic Attack

Readmissions after stroke are not only associated with greater levels of disability and a higher risk of mortality but also increase overall medical costs. Predicting readmission risk and understanding its causes are thus essential for healthcare resource allocation and quality improvement planning. By using machine learning techniques on initial admission data, this study aimed to develop prediction models for readmission or mortality after stroke. During model development, resampling methods were implemented to balance the class distribution. Two-layer nested cross-validation was used to build and evaluate the prediction models. A total of 3422 patients were included for analysis. The 90-day rate of readmission or mortality was 17.6%. This study identified several important predictive factors, including age, prior emergency department visits, pre-stroke functional status, stroke severity, body mass index, consciousness level, and use of a nasogastric tube. The Naïve Bayes model with class weighting to compensate for class imbalance achieved the highest discriminatory capacity in terms of the area under the receiver operating characteristic curve (0.661). Despite having room for improvement, the prediction models could be used for early risk assessment of patients with stroke. Identification of patients at high risk for readmission or mortality immediately after admission has the potential of enabling early discharge planning and transitional care interventions.

Effectiveness of a Comprehensive Patient-centered Hospital Discharge Planning Intervention for Frail Older Adults

Effectiveness of a Comprehensive Patient-centered Hospital Discharge Planning Intervention for Frail Older Adults

Inpatient Quality Improvement Interventions for Asthma: A Meta-analysis.

Despite the availability of evidence-based guidelines for the management of pediatric asthma, health care utilization remains high. Systematically review the inpatient literature on asthma quality improvement (QI) and synthesize impact on subsequent health care utilization. Medline and Cumulative Index to Nursing and Allied Health Literature (January 1, 1991-November 16, 2016) and bibliographies of retrieved articles. Interventional studies in English of inpatient-initiated asthma QI work. Studies were categorized by intervention type and outcome. Random-effects models were used to generate pooled risk ratios for health care utilization outcomes after inpatient QI interventions. Thirty articles met inclusion criteria and 12 provided data on health care reutilization outcomes. Risk ratios for emergency department revisits were: 0.97 (95% confidence interval [CI]: 0.06-14.47) <30 days, 1.70 (95% CI: 0.67-4.29) for 30 days to 6 months, and 1.22 (95% CI: 0.52-2.85) for 6 months to 1 year. Risk ratios for readmissions were: 2.02 (95% CI: 0.73-5.61) for <30 days, 1.68 (95% CI: 0.88-3.19) for 30 days to 6 months, and 1.27 (95% CI 0.85-1.90) for 6 months to 1 year. Subanalysis of multimodal interventions suggested lower readmission rates (risk ratio: 1.49 [95% CI: 1.17-1.89] over a period of 30 days to 1 year after the index admission). Subanalysis of education and discharge planning interventions did not show effect. Linkages between intervention and outcome are complicated by the multimodal approach to QI in most studies. We did not identify any inpatient strategies impacting health care reutilization within 30 days of index hospitalization. Multimodal interventions demonstrated impact over the longer interval.

A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial

Objective: To compare the cost effectiveness of two occupational therapy–led discharge planning interventions from the HOME trial. Design: An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years. Setting: Medical and acute care wards of Australian hospitals (n=5). Subjects: A total of 400 people ≥ 70 years of age. Interventions: Participants were randomized to either (1) an enhanced program (HOME), involving pre/post discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment. Main measures: Nottingham Extended Activities of Daily Living (global measure of activities of daily living) and SF-12V2, transformed into SF-6D (quality-adjusted life year) measured at baseline and three months post discharge. Results: The cost of the enhanced program was higher than that of the in-hospital consultation. However, a higher proportion of patients showed improvement in activities of daily living in the enhanced program with an incremental cost-effectiveness ratio of $61,906.00 per person with clinically meaningful improvement. Conclusion: Health services would not save money by implementing the enhanced program as a routine intervention in medical and acute care wards. Future research should incorporate longer time horizons and consider which patient groups would benefit from home visits.

Prediction of post-acute care demand in medical and neurological inpatients: diagnostic assessment of the post-acute discharge score \u2013 a prospective cohort study

BackgroundEarly identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital stays. With a focus on interprofessional assessment of biopsychosocial risk, this study’s aim was to assess medical and neurological patients’ post-acute care discharge (PACD) scores on days 1 and 3 after hospital admission regarding diagnostic accuracy and effectiveness as an early screening tool. The transfer to PAC facilities served as the outcome (“gold standard”).MethodsIn this prospective cohort study, registered at ClinicalTrial.gov (NCT01768494) on January 2013, 1432 medical and 464 neurological patients (total n = 1896) were included consecutively between February and October 2013. PACD scores and other relevant data were extracted from electronic records of patient admissions, hospital stays, and interviews at day 30 post-hospital admission. To gauge the scores’ accuracy, we plotted receiver operating characteristic (ROC) curves, calculated area under the curve (AUC), and determined sensitivity and specificity at various cut-off levels.ResultsMedical patients’ day 1 and day 3 PACD scores accurately predicted discharge to PAC facilities, with respective discriminating powers (AUC) of 0.77 and 0.82. With a PACD cut-off of ≥8 points, day 1 and 3 sensitivities were respectively 72.6% and 83.6%, with respective specificities of 66.5% and 70.0%. Neurological patients’ scores showed lower accuracy both days: using the same cut-off, respective day 1 and day 3 AUCs were 0.68 and 0.78, sensitivities 41.4% and 68.7% and specificities 81.4% and 83.4%.ConclusionPACD scores at days 1 and 3 accurately predicted transfer to PAC facilities, especially in medical patients on day 3. To confirm and refine these results, PACD scores’ value to guide discharge planning interventions and subsequent impact on hospital stay warrants further investigation.Trial registrationClinialTrials.gov Identifier, NCT01768494.

OP39 Evaluation Of Discharge Planning And Transitional Care For The Elderly

Introduction:According to our local data, elderly patients accounted for 14 percent of the population yet, represent 58 percent of hospitalization and, they are more likely to return after discharge. These patients are more likely to return to the hospital following discharge. In order to meet ministerial target for length of stay of patient on a stretcher, the UETMIS-SS was requested to evaluate interventions aiming to improve the fluidity of patient trajectories in the acute care services. The objective of this health technology assessment is to evaluate the effectiveness of discharge planning and transitional care interventions aiming at reducing the readmission rate of the elderly.Methods:An umbrella review was conducted following the PRISMA statement to summarize the scientific evidence. The search was conducted in five databases along with the grey literature search. Two reviewers independently performed the study selection, the quality assessment and the data extraction. To better illustrate the activities and the healthcare professionals (HCP) involved in the interventions, an analytical framework was developed. Results were summarized in a narrative synthesis. The contextual and experiential data were collected through interviews with HCP and directorates from different settings. The level of evidence was and a committee was then held to elaborate the recommendations.Results:In the nine systematic reviews included in the narrative synthesis, three models were identified: Post-discharge planning and follow-up by the same HCP was established to be effective in reducing the readmission rate. Discharge planning interventions with follow-up by non-specific HCP have been shown to be promising, while discharge planning without follow-up after the hospital discharge has shown to be ineffective in reducing the readmission rate.Conclusions:An individualized discharge plan, coordination of services and follow-up performed by the same HCP is established to be effective in reducing readmission rate.

Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home.

To determine the effectiveness of nursing discharge planning interventions on health-related outcomes for older inpatients discharged home. Inadequate discharge planning for the ageing population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing interventions for older people. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be evaluated in practice. Systematic review and meta-analysis. A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000-2015. Critical appraisal, data extraction and meta-analysis followed the methodology of the Joanna Briggs Institute. Thirteen studies were included in the review, 2 of 13 were pilot studies and one had a pre-post design. Included studies involved 3,964 participants with a median age of 77years. Nurse discharge planning did not significantly reduce hospital readmission or quality of life, except readmission was lower across studies conducted in the USA. The overall effect score for nurse discharge planning on length of stay was statistically significant and positive. Nursing discharge planning is a complex intervention and difficult to evaluate. Findings suggest that nursing discharge planning for older inpatients discharged home increases the length of stay yet neither reduces readmission rate nor improves quality of life.

Gender differences in discharge dispositions of emergency department visits involving drug misuse and abuse\u20142004-2011

BackgroundDrug use-related visits to the emergency department (ED) can undermine discharge planning and lead to recurrent use of acute services. Yet, little is known about where patients go post discharge. We explored trends in discharge dispositions of drug-involved ED visits, with a focus on gender differences.MethodsWe extracted data from the 2004–2011 Drug Abuse Warning Network, a national probability sample of drug-related visits to hospital EDs in the U.S. We computed weighted multinomial logistic regression models to estimate discharge dispositions over time and to examine associations between gender and the relative risk of discharge dispositions, controlling for patient characteristics.ResultsThe final pooled sample included approximately 1.2 million ED visits between 2004 and 2011. Men accounted for more than half (57.6%) of all ED visits involving drug misuse and abuse. Compared with women, men had a greater relative risk of being released to the police/jail, being referred to outpatient detox or other treatment, and leaving against medical advice than being discharged home. The relative risk of being referred to outpatient detox/drug treatment than discharged home increased over time for men versus women.ConclusionsGreater understanding of gender-based factors involved in substance-related ED visits and treatment needs may inform discharge planning and preventive interventions.

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English-language articles published between 1990 and April 2016. Hospital or skilled nursing facility. Older adults with informal caregivers discharged to a community setting. Readmission rates, length of and time to post-discharge rehospitalizations, costs of postdischarge care. Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62-0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64-0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission.

Effectiveness of nursing discharge planning interventions on health-related outcomes in discharged elderly inpatients: a systematic review.

Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice. To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions. Elderly inpatients aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals to home. The review focused on the six keys components of Naylor's Transitional Care Model: early geriatric assessment, discharge preparation, patient or caregiver's participation, continuity of care, day of discharge assessment and post-discharge follow-up. This review considered randomized and non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. The outcomes for this review were functional ability, symptoms management, adverse outcomes, unmet needs after discharge, coping with disease, health-related quality of life (QoL), satisfaction with care, readmission rate and healthcare utilization. A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000 and 2015. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Quantitative data were extracted from included studies independently by the two reviewers using the standardized data extraction tool from JBI-MAStARI. Due to the wide range of outcome measures, a comprehensive meta-analysis for all studies was not possible. However, meta-analysis was conducted for specific outcome measures, such as readmission, length of stay and QoL. Thirteen studies met the inclusion criteria and were included in the review. Two out of the 13 studies were pilot studies and one had a pre-post design. Included studies involved a total of 3964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission rate (odds ratio [OR] = 0.73, 95% confidence intervals [CIs] = 0.53-1.01, P = 0.06). The overall effect score for length of stay was significant (weighted mean difference = 0.29, P < 0.01), suggesting that discharge planning increased the length of hospitalization. The effectiveness of discharge planning did not significantly impact QoL (mental OR = 0.37, P = 0.19 and physical OR = 0.47, P = 0.15). Findings of this review suggest that nursing discharge planning for elderly inpatients discharged home increases length of stay, yet neither reduces readmission rates nor improves QoL.

Randomized Trial of a Discharge Planning and Telehealth Intervention for Patients Aged 65 and older after Coronary Artery Bypass Surgery

Background: It is well established that older patients are at increased risk for developing complications after cardiac surgery due to advanced disease, impaired cardiac status, and comorbidities. Objective: This study reports on the results of a telehealth and telephone Discharge Intervention for Cardiac Elderly (DICE) for patients ≥ age 65.

Hospital readmissions in frail older people

SummaryThe majority of hospital in-patients are older people, and many of these are at increased risk of readmission, which can be an adverse outcome for the patient. Currently there is poor understanding as to how best to reduce the risk of readmission. We searched MEDLINE, EMBASE and the Cochrane library for high quality review articles about readmissions. Each review was quality assessed by two reviewers. Grouped data and evidence from original papers is cited with 95% confidence intervals when possible. Nine review studies of sufficient quality were included. Two addressed risk factors for readmission, which included: age, poor functional status prior to admission, length of stay during the index admission, depression, cognitive impairment, malnutrition, social support and social networks/support. The seven other reviews addressed interventions to reduce readmission, which included: discharge planning, post-discharge support, post-discharge case management, and nutritional supplementation. It is possible to identify older people at risk of readmission using well-established risk factors; discharge planning, post-discharge support and nutritional interventions appear to be effective in reducing readmission. Combined interventions appear to be more effective than isolated interventions.

Effectiveness of nursing discharge planning interventions on health-related outcomes in elderly inpatients discharged home: a systematic review protocol

Review question/objective The aim of this systematic review is to determine the best available evidence of the effectiveness of discharge planning interventions involving at least one nurse on health related outcomes, including, but not limited to, functional limitations, symptom management, unmet needs and/or health related quality of life for elderly inpatients discharged home. Furthermore, the objective of this study is to assess the relative impact of individual components of discharge planning interventions Inclusion criteria Types of participants This review will consider studies that included elderly inpatients, aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals (including skilled nursing home facilities) to home. Types of intervention(s)/phenomena of interest This review will consider studies that assess the following nursing discharge planning interventions: 1. Early geriatric assessment 2. Discharge preparation: education/teaching medication self-management, developing self-care management skills, symptoms management, effective communication and information about discharge plan, effective multidisciplinary communication 3. Patient or caregivers participation/involvement to the discharge planning and decision making related to discharge destination 4. Continuity of care (coordination and effective communication between hospital staff, primary care and health care providers, coordination of the patient’s discharge/transitional plan, management of patient’s transition and post discharge needs 5. Day of discharge assessment regarding discharge planning (medication reconciliation, completion and explanation to the patient of the discharge summary) and 6. Post discharge follow-up (home care follow up/visits, follow-up phone calls). This systematic review will focus on discharge planning interventions: i) provided by at least one nurse; and ii) which are incorporated into a multidisciplinary and/or interdisciplinary model of care. Types of outcomes This review will consider studies that include the following outcome measures: 1.) Functional ability/functional limitations 2.) Symptoms/medical condition management/adverse outcomes 3.) Unmet needs after hospital discharge 4.) Coping with disease /coping difficulties 5.) Health related quality of life 6.) Satisfaction with care during the discharge planning process 7.) Health care utilization (eg number of hospital visits).

Eine bedarfsorientierte Entlassplanungsintervention bei Patienten mit hoher Inanspruchnahme des psychiatrischen Versorgungssystems: Qualität der Umsetzung und Verbesserungsmöglichkeiten

Process evaluation of a needs-oriented discharge planning and monitoring (NODPAM) intervention for patients with severe mental illness with high utilisation of inpatient psychiatric care (within a RCT showing lack of evidence of superiority over treatment as usual). Analysis of intervention drop-outs vs. intervention group patients participating in the intervention; analysis of the impact of intervention characteristics on unmet needs over time. Patients with more severe forms of illness were more likely to be among intervention drop-outs, a relatively high proportion of unmet needs persisted in patients participating in the intervention. Good intervention implementation and high patient satisfaction with the intervention were associated with a reduction of unmet needs. The NODPAM intervention failed to reach patients with high service use and more severe forms of illness; quality of intervention implementation might have contributed to the lack of superiority over treatment as usual. The intervention might not have been well integrated in routine treatment and was therefore experienced as extraneous to routine care.

Targeting Hospitalized Patients for Early Discharge Planning Intervention

Targeting Hospitalized Patients for Early Discharge Planning Intervention