Authors' objectives:

This review was conducted to test the following general hypotheses: - there is an inadequate number of comparable randomised controlled trials (RCTs) to allow a definitive analysis. - hospital discharge process, outcome and cost-effectiveness can be improved through the use of a variety of interventions. - some interventions are more effective than others. - there are priority areas for future research.

Authors' results and conclusions: Overall analysis by intervention characteristics: Overall no significant effect was seen on mortality at 3 months, 6 months or 12 months after discharge. Index length of stay was not significantly affected by the interventions. The risk of readmission to hospital was significantly reduced by intervention. This effect was preserved where the intervention was provided by a single professional, compared to a team. The effect on readmission risk was most apparent in interventions provided both in hospital and in the patients home. A similar trend was seen for interventions provided in the patients home only. Little effect was seen for interventions provided only in hospital or by telephone. Other outcome measures were not collected or reported consistently in the trials and only limited analysis was possible. Analysis by intervention type: None of the four intervention types were shown to have major effects on mortality or length of hospital stay. Only educational interventions had an effect on readmission risk ratio. However, the trials were limited in focus and this result may not be generalisable outside selected patient subgroups.

Authors' recommendations: The evidence from these trials does not suggest that discharge arrangements have effects on mortality or length of hospital stay. This review supports the concept that arrangements for discharging older people from hospital can have beneficial effects on subsequent readmission rates. Interventions provided across the hospital-community interface, both in hospital and in the patient's home, showed the largest effect. Evidence from RCTs is not available to support the general adoption of discharge planning protocols, geriatric assessment processes or discharge support schemes as means of improving discharge outcomes.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1001

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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