Joel C Boggan, Spoorthi Sankineni, Paul A Dennis, Dazhe Chen, Tina Wong Sledge, David Halpern, Sharron Rushton, John W Williams, Tatyana Der, Amir Alishahi Tabriz, Adelaide M Gordon, Morgan Jacobs, Nathan A Boucher, Maria Colandrea, Anastasia-Stefania Alexopoulos, Joanne Roman Jones, Nina Leflore-Lloyd, Sarah Cantrell, Karen M Goldstein, Jennifer M Gierisch
{"title":"同步出院后接触对医疗服务使用和患者满意度的影响：系统回顾和荟萃分析。","authors":"Joel C Boggan, Spoorthi Sankineni, Paul A Dennis, Dazhe Chen, Tina Wong Sledge, David Halpern, Sharron Rushton, John W Williams, Tatyana Der, Amir Alishahi Tabriz, Adelaide M Gordon, Morgan Jacobs, Nathan A Boucher, Maria Colandrea, Anastasia-Stefania Alexopoulos, Joanne Roman Jones, Nina Leflore-Lloyd, Sarah Cantrell, Karen M Goldstein, Jennifer M Gierisch","doi":"10.7326/ANNALS-24-01140","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Postdischarge contacts (PDCs) after hospitalization are common practice, but their effectiveness in reducing use of acute care after discharge remains unclear.</p><p><strong>Purpose: </strong>To assess the effects of PDC on 30-day emergency department (ED) visits, 30-day hospital readmissions, and patient satisfaction.</p><p><strong>Data sources: </strong>MEDLINE, Embase, and CINAHL searched from 2012 to 25 May 2023.</p><p><strong>Study selection: </strong>Randomized and nonrandomized trials of PDC within 7 days.</p><p><strong>Data extraction: </strong>Two investigators independently screened articles and assessed risk of bias (ROB). Single reviewers extracted data, with verification by second investigators. Random-effects meta-analyses were done on outcomes shared by at least 3 studies, and the certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.</p><p><strong>Data synthesis: </strong>Of 13 included studies (11 randomized trials [RTs]), 12 delivered PDCs via telephone. Three of 11 RTs were rated as having low ROB, with 1 rated high. Most PDC interventions (<i>n</i> = 10) consisted of single telephone contacts, often within 3 days. Eight studies focused on patients identified as higher-risk by the authors. There were no differences in 30-day ED use (5 RTs; 3054 patients; risk difference, 0.00 [95% CI, -0.02 to 0.03]; moderate certainty) or 30-day hospital readmissions (7 RTs; 7075 patients; risk difference, 0.00 [CI, -0.02 to 0.02]; moderate certainty) with PDC.</p><p><strong>Limitation: </strong>Adherence and fidelity to PDC interventions were poorly described, and only 1 study investigated nontelephone PDC.</p><p><strong>Conclusion: </strong>Postdischarge contacts within 7 days of discharge were not associated with reductions in 30-day ED use or readmissions compared with usual care. Health systems should reconsider the utility of universal PDCs because multifaceted interventions targeting higher-risk patients may be necessary to reduce use of acute care after discharge.</p><p><strong>Primary funding source: </strong>Department of Veterans Affairs. (PROSPERO: CRD42023465675).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"229-240"},"PeriodicalIF":19.6000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of Synchronous Postdischarge Contacts on Health Care Use and Patient Satisfaction : A Systematic Review and Meta-analysis.\",\"authors\":\"Joel C Boggan, Spoorthi Sankineni, Paul A Dennis, Dazhe Chen, Tina Wong Sledge, David Halpern, Sharron Rushton, John W Williams, Tatyana Der, Amir Alishahi Tabriz, Adelaide M Gordon, Morgan Jacobs, Nathan A Boucher, Maria Colandrea, Anastasia-Stefania Alexopoulos, Joanne Roman Jones, Nina Leflore-Lloyd, Sarah Cantrell, Karen M Goldstein, Jennifer M Gierisch\",\"doi\":\"10.7326/ANNALS-24-01140\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Postdischarge contacts (PDCs) after hospitalization are common practice, but their effectiveness in reducing use of acute care after discharge remains unclear.</p><p><strong>Purpose: </strong>To assess the effects of PDC on 30-day emergency department (ED) visits, 30-day hospital readmissions, and patient satisfaction.</p><p><strong>Data sources: </strong>MEDLINE, Embase, and CINAHL searched from 2012 to 25 May 2023.</p><p><strong>Study selection: </strong>Randomized and nonrandomized trials of PDC within 7 days.</p><p><strong>Data extraction: </strong>Two investigators independently screened articles and assessed risk of bias (ROB). Single reviewers extracted data, with verification by second investigators. Random-effects meta-analyses were done on outcomes shared by at least 3 studies, and the certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.</p><p><strong>Data synthesis: </strong>Of 13 included studies (11 randomized trials [RTs]), 12 delivered PDCs via telephone. Three of 11 RTs were rated as having low ROB, with 1 rated high. Most PDC interventions (<i>n</i> = 10) consisted of single telephone contacts, often within 3 days. Eight studies focused on patients identified as higher-risk by the authors. There were no differences in 30-day ED use (5 RTs; 3054 patients; risk difference, 0.00 [95% CI, -0.02 to 0.03]; moderate certainty) or 30-day hospital readmissions (7 RTs; 7075 patients; risk difference, 0.00 [CI, -0.02 to 0.02]; moderate certainty) with PDC.</p><p><strong>Limitation: </strong>Adherence and fidelity to PDC interventions were poorly described, and only 1 study investigated nontelephone PDC.</p><p><strong>Conclusion: </strong>Postdischarge contacts within 7 days of discharge were not associated with reductions in 30-day ED use or readmissions compared with usual care. Health systems should reconsider the utility of universal PDCs because multifaceted interventions targeting higher-risk patients may be necessary to reduce use of acute care after discharge.</p><p><strong>Primary funding source: </strong>Department of Veterans Affairs. (PROSPERO: CRD42023465675).</p>\",\"PeriodicalId\":7932,\"journal\":{\"name\":\"Annals of Internal Medicine\",\"volume\":\" \",\"pages\":\"229-240\"},\"PeriodicalIF\":19.6000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Internal Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.7326/ANNALS-24-01140\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/14 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7326/ANNALS-24-01140","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/14 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Effectiveness of Synchronous Postdischarge Contacts on Health Care Use and Patient Satisfaction : A Systematic Review and Meta-analysis.
Background: Postdischarge contacts (PDCs) after hospitalization are common practice, but their effectiveness in reducing use of acute care after discharge remains unclear.
Purpose: To assess the effects of PDC on 30-day emergency department (ED) visits, 30-day hospital readmissions, and patient satisfaction.
Data sources: MEDLINE, Embase, and CINAHL searched from 2012 to 25 May 2023.
Study selection: Randomized and nonrandomized trials of PDC within 7 days.
Data extraction: Two investigators independently screened articles and assessed risk of bias (ROB). Single reviewers extracted data, with verification by second investigators. Random-effects meta-analyses were done on outcomes shared by at least 3 studies, and the certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.
Data synthesis: Of 13 included studies (11 randomized trials [RTs]), 12 delivered PDCs via telephone. Three of 11 RTs were rated as having low ROB, with 1 rated high. Most PDC interventions (n = 10) consisted of single telephone contacts, often within 3 days. Eight studies focused on patients identified as higher-risk by the authors. There were no differences in 30-day ED use (5 RTs; 3054 patients; risk difference, 0.00 [95% CI, -0.02 to 0.03]; moderate certainty) or 30-day hospital readmissions (7 RTs; 7075 patients; risk difference, 0.00 [CI, -0.02 to 0.02]; moderate certainty) with PDC.
Limitation: Adherence and fidelity to PDC interventions were poorly described, and only 1 study investigated nontelephone PDC.
Conclusion: Postdischarge contacts within 7 days of discharge were not associated with reductions in 30-day ED use or readmissions compared with usual care. Health systems should reconsider the utility of universal PDCs because multifaceted interventions targeting higher-risk patients may be necessary to reduce use of acute care after discharge.
Primary funding source: Department of Veterans Affairs. (PROSPERO: CRD42023465675).
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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