Original Title: Factores predictivos e intervenciones efectivas para la reducción del riesgo de reingreso hospitalario en pacientes de edad avanzada

Authors' objectives: • To identify the predictive factors of hospital readmissions in people with advanced age (75 years or older). • To identify the effective interventions to reduce the risk or number of hospital readmissions in people with advanced age (75 years or older).

Authors' results and conclusions: RESULTS: During the review of factors, a total of 1316 references were identified. After duplicates were discarded, the figure reduced to 988 references. For its complete review, 47 articles were selected but only 9 were included. The review of list of references and the manual review yielded 2 additional references, so finally, one systematic review and 10 primary studies were included. The objective of the prospective cohort studies was to know what factors affected the risk of hospital readmission through multivariate regressions. Age and sex were relevant factors only in two models. Other socio-demographic characteristics like marital status, place of residence, education level or factors related to informal caregivers were explicative in some models. Among the factors related to the health care received, to have a previous admission or the duration of the hospital stay were relevant factors. Other studies found also the number of drugs as a predictive factor. The Charlson Index was used in three studies, two of them found it relevant. To suffer one or another disease was a risk factor in several studies. Five studies included in the regressions the functional ability: three of them found that the limitation of the activities of daily living was a predictive factor of hospital readmission. Related to the review of interventions, 1755 references were identified. After duplicates were discarded the figure reduced to 1056 references. For its complete review, 92 articles were selected, 40 of them were included. The review of list of references and the manual review yielded 5 additional references. Finally, 16 systematic reviews and 29 clinical trials (23 randomized and 6 non-randomized) were included. These trials evaluated three types of interventions: geriatric evaluation and management at hospital, home care and pharmaceutical management. In general, the conclusions about the effectiveness of the different interventions on readmissions are a mix of positive effects, lack of effects and even negative effects. Most of the clinical trials included did not find any effect of the intervention on the risk of readmission in older patients. Moreover, two studies found negative effects, that is, an increase of readmissions in the intervention group. On the other hand, nine clinical trials showed a positive effect of the assessed intervention, although some studies only partially, depending on the duration of the follow up. Some evidence was found that supports the conclusion that the interventions which include the geriatric management at hospital and home care, have more success in avoiding or decreasing the hospital readmission in older patients. These integral services need a high level of collaboration and communication among geriatrists, patients, caregivers, general practitioners and other agents. CONCLUSIONS: • According to the evidence, there are several factors that could be related to the risk of hospital readmission of people with advanced age: a previous hospital admission, the duration of the hospital stay, the morbidity and comorbidity, the functional ability and several social and psychological measures. • The interventions developed before discharge are less effective if there is a lack of follow up after discharge. The interventions related to the activities developed in hospital before discharge and the coordination of care after discharge, are more likely to reduce the risk of hospital readmission in aged patients.

Authors' methods: METHODS: Two systematic reviews of literature were carried out in order to fulfil both objectives. Two strategy searches were designed combining the terms readmission and aged among others, and were applied in several databases: MEDLINE, EMBASE, MEDLINE in process, CINAHL, Science Citation Index, Social Science Citation Index, Índice Médico Español, Google Scholar y LILACS. The strategy for systematic review of interventions was applied in CRD and CENTRAL databases as well. The search strategy for the systematic review of interventions included a filter for clinical trials. Date and language limits were not applied. The list of references of included studies was also reviewed. The selection criteria were articles published in English or Spanish, which studied the unplanned hospital readmissions in patients of 75 years old or more who had been admitted in hospital for any health problem (studies focused in a specific disease were excluded). The type of selected studies was different for the two systematic reviews. The review of factors included follow up prospective studies with appropriate statistical analysis, like logistic regression, to explore the relation between the risk of readmission with clinic, demographic, social or other type of factor. The review of interventions included randomized and nonrandomized clinical trials which evaluated the effectiveness of interventions developed during the admission and/or the follow up whose aim was to reduce the risk of hospital readmission. Two reviewers selected independently the studies. The data extraction and the quality assessment were carried out by a reviewer and checked by a second reviewer. The data were gathered in spreadsheets designed ad hoc. Where the reviewers disagreed, they would negotiate. When consensus was not reached, a third reviewer was consulted. The quality of included studies was assessed according to CRD (University of York) criteria for systematic reviews, the CASPe tool for cohort studies and SIGN tool for clinical trials. The quality of statistical analysis of logistic regression (systematic review of factors) was also assessed. The data collected was synthesized through narrative procedures with detailed tables.

Project Status: Completed

Year Published: 2009

URL for published report: https://sescs.es/factores-predictivos-e-intervenciones-efectivas-para-la-reduccion-del-riesgo-de-reingreso-hospitalario/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es