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Transitional care interventions on hospital discharge reduce readmissions by more than half

Patients given transitional care before and during discharge from hospital are less likely to be readmitted, according to new research from the University of Manchester.

The systematic review and network meta-analysis was published in the journal JAMA Network Open considered data from 126 trials with 97,408 participants.

It showed that interventions were associated with significant reductions in readmissions at 180 days post-discharge.

While the types of changes implemented differed across the studies, common changes included improved discharge planning, medication review, case management, multi-agency team meetings, psychological support, home visits and peer support.

Low complexity interventions comprised of one to three changes to usual care applied together and were associated with a 55% reduction in readmissions at 180 days post-discharge.

The medium complexity interventions, with four to seven changes to usual care, were associated with a 42% reduction during the same time period.

Even at 30 days, the low complexity interventions were associated with a 22% decrease in the odds of readmission and the medium complexity interventions were associated with a 18% decrease.

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For high complexity interventions, which included eight or more changes to usual practice applied together, were associated with a 24% reduction in readmissions at 180 days post-discharge.

Principle investigator Maria Panagioti, senior lecturer from The University of Manchester, said: ‘This study shows that more changes to usual practice are not always better to reduce health care needs and prevent emergency department visits for patients transitioning from hospital to the community.

‘We need to think about what changes to the usual care are truly meaningful for patients, whether professionals can implement those changes and how those changes can work together as a coherent bundle of care.

‘We strongly recommend that the NHS develops of a set of patient and staff-reported outcomes to better capture the full range of benefits and impacts of transitional care interventions especially those of high complexity.’

Natasha Tyler, research fellow from the University of Manchester and lead author of the study, added: ‘This study shows that transitional care arrangements are a powerful way to avoid readmission to hospital because patients feel more involved in decisions and supported during a particularly vulnerable stage in the care pathway.

‘It is well known that an increased demand for urgent hospital care has created pressure to discharge patients to the community. We know some of those patients are discharged too early or without necessary support to recover in the community.

‘There is also evidence that one in five patients may experience suboptimal or unsafe care around the time of discharge from hospital mainly because of the prompt reduction in continuity of care and co-ordination challenges of multiple independent professionals and agencies.

‘This is why it is important to understand the value of intermediate care and how best that is delivered.’