Interventions to Reduce 30-day Rehospitalization: A Systematic Review

Ann Intern Med. 2011 Oct 18;155(8):520-8. doi: 10.7326/0003-4819-155-8-201110180-00008.

Abstract

Background: About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days. Beginning in 2013, hospitals with high risk-standardized readmission rates will be subject to a Medicare reimbursement penalty.

Purpose: To describe interventions evaluated in studies aimed at reducing rehospitalization within 30 days of discharge.

Data sources: MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched for reports published between January 1975 and January 2011.

Study selection: English-language randomized, controlled trials; cohort studies; or noncontrolled before-after studies of interventions to reduce rehospitalization that reported rehospitalization rates within 30 days.

Data extraction: 2 reviewers independently identified candidate articles from the results of the initial search on the basis of title and abstract. Two 2-physician reviewer teams reviewed the full text of candidate articles to identify interventions and assess study quality.

Data synthesis: 43 articles were identified, and a taxonomy was developed to categorize interventions into 3 domains that encompassed 12 distinct activities. Predischarge interventions included patient education, medication reconciliation, discharge planning, and scheduling of a follow-up appointment before discharge. Postdischarge interventions included follow-up telephone calls, patient-activated hotlines, timely communication with ambulatory providers, timely ambulatory provider follow-up, and postdischarge home visits. Bridging interventions included transition coaches, physician continuity across the inpatient and outpatient setting, and patient-centered discharge instruction.

Limitations: Inadequate description of individual studies' interventions precluded meta-analysis of effects. Many studies identified in the review were single-institution assessments of quality improvement activities rather than those with experimental designs. Several common interventions have not been studied outside of multicomponent "discharge bundles."

Conclusion: No single intervention implemented alone was regularly associated with reduced risk for 30-day rehospitalization.

Primary funding source: None.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Aftercare / standards
  • Appointments and Schedules
  • Fee-for-Service Plans / standards
  • Hotlines
  • House Calls
  • Humans
  • Medicare / standards
  • Medication Reconciliation
  • Patient Discharge / standards*
  • Patient Education as Topic
  • Patient Readmission / standards*
  • Primary Health Care
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Telephone
  • United States