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Management Brief No. 222

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Management Briefs
Issue 222 May 2024

The report is a product of the VA/HSR Evidence Synthesis Program.

Effectiveness of Post-Discharge Contacts on Health Care Utilization and Patient Satisfaction: A Systematic Review

Takeaway: Post-discharge interventions delivered within 7 days of hospital discharge were not associated with a reduction in 30-day hospital readmissions, emergency department use, or patient satisfaction with care when compared with usual care.

The transition from hospital to home is a vulnerable period when many patients are at risk of experiencing adverse events and unplanned healthcare use. Over the past decade, there has been an increased focus on transitional care from hospital to home, aimed at reducing readmissions, lowering healthcare costs, and improving patient satisfaction. Various transitional care models have been developed that produce modest but meaningful reductions in hospital readmissions. Once back at home, however, patients may experience uncertainty about self-care, leading to complications. Such post-discharge complications may stem from poor communication of unresolved medical problems, lack of patient education on medications and treatments, limited monitoring of medication adherence, and delayed monitoring of patient status after discharge.

Although many healthcare providers follow up with patients in the week after discharge—usually through a phone call within the first 2 to 3 days after leaving the hospital—prior studies on the effectiveness of these post-discharge approaches have produced mixed results regarding impacts on hospital readmission, emergency department use, and patient satisfaction with care.

In response to a request from VA’s Office of Primary Care, the ESP Center at the Durham VA Health Care System conducted a systematic review to assess the impact of post-discharge contacts in the first 7 days after hospital discharge on emergency care use, hospital readmission rates, and patient satisfaction with care. Investigators searched for articles in MEDLINE, Embase, and CINAHL for relevant studies published from 2012 to May 25, 2023.

Investigators identified 13 studies that assessed the impact of post-discharge contacts (PDC), most of which (N = 11) were randomized controlled trials (RCT), and with only one RCT rated as high risk of bias. All studies included adults with an acute medical hospitalization; none focused on populations with an acute psychiatric hospitalization. All but 1 study delivered the intervention via telephone, and most (N = 11) consisted of a single contact conducted in the first 3 days after hospital discharge. Eight of the studies focused on patients identified as higher risk based on factors such as age (i.e., 65 and older) and medical comorbidities (e.g., COPD, heart failure). Meta-analyses were performed for studies of sufficient similarity and showed no impact of PDC on odds of 30-day hospital readmissions or 30-day ED utilization. Only 4 studies assessed the impact of PDC on patient satisfaction, with only 1 small study reporting higher patient satisfaction among patients receiving post-discharge contacts.

Summary of Findings

Post-discharge follow-up contacts delivered within 7 days of hospital discharge likely have no impact on 30-day hospital readmissions, emergency department use, or patient satisfaction with care when compared with usual care. Certainty of evidence supporting this conclusion was considered moderate, based primarily on the consistency of results across randomized studies.

Findings should be tempered by a lack of information on intervention implementation across included studies.

Implications

While this review did not find evidence of significant impacts of brief post-discharge contact approaches, healthcare systems such as VHA should consider the cost-effectiveness of these relatively simple approaches on costly outcomes and should balance widespread brief PDCs with potential investment in more intensive post-discharge approaches that focus on higher-risk patients most likely to benefit from these interventions.

Limitations

Limitations of the evidence include those associated with the identified literature as well as the review’s approach. Many studies were small (median sample size of 311), and only 1 study reported subgroups by patient characteristics such as race and health literacy. None of the identified studies assessed PDC for patients with acute psychiatric hospitalizations—key question of the review—and none were conducted within VA’s healthcare system. Additionally, the review’s definition of PDC did not include interventions that focused only on electronic symptom monitoring.

Future Research

This comprehensive literature review identified several gaps in the current evidence that warrant future investigation. Future research should include studies that:

  • Focus on patients with psychiatric hospitalizations.
  • Provide subgroup (e.g., age, comorbidities, race, and other social determinants of health) analyses.
  • Feature multi-contact and/or multi-modal (e.g., virtual and nonvirtual) interventions.
  • Directly compare video vs. in-person vs. phone or other messaging modalities, with variable doses and timing of PDCs.
  • Focus on outcomes that include:
    • Well-specified measures of patient experience pertaining specifically to the PDC intervention.
    • Patient comprehension of the discharge plan and adherence to that plan.
  • Examine the fidelity to the designed intervention(s) (e.g., number and duration of contacts received by each patient).



Boggan JC, Sankineni S, Gordon AM, et al. Effectiveness of Post-Discharge Contacts on Health Care Utilization and Patient Satisfaction: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Systems Research, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-010; 2024.

To view the full report, go to: vaww.hsrd.research.va.gov/publications/esp/pdc.cfm (Intranet only).

ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.



This Management Brief is provided to inform you about recent HSR findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR Resource Center charged with disseminating important HSR findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.

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