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Table 2 Meta-analyses of randomized controlled trials of the effect of clinical interventions before and/or after hospital discharge on hospital readmission rates

From: The effect of clinical interventions on hospital readmissions: a meta-review of published meta-analyses

Reference (AMSTAR score) Intervention RCTs reporting HRR (n) Total number of patients RR or OR of HRR in intervention / control (95% CI)
Heart failure
Home care
Lambrinou et al. 2012 [32] (9) Before hospital discharge: individualized patient education and discharge planning. After discharge: home care by cardiac community nurses or physicians 6 1,052 0.80 (0.70- 0.91)
Takeda et al. 2012 [33] (10) Disease management with home visits and phone calls 7 2,199 0.75 (0.57-0.99)
Multidisciplinary care 2 403 0.46 (0.30-0.69)
Tsai et al. 2005 [34] (6) Chronic care model including: follow-up, planned visits, self-management (patient education) 16 4,324 0.73 (0.58-0.91)+
Whellan et al. 2005 [35] (3) Discharge planning and disease management with home nursing 6 2,710 0.7 (0.6 - 0.9) +++
Roccaforte et al. 2005 [36] (9) Disease management interventions before and after discharge (education, discharge planning, home or clinic care) 25 2,603 0.80 (0.68-0.94)
Holland et al. 2005 [37] (8) Multidisciplinary interventions with 1–8 home visits 10 1,519 0.80 (0.71-0.89)
Kim and Soeken 2005 [38] (7) Inhospital assessment and education with follow up by phone and home visits 4 817 0.75 (0.45-1.05)
Gonseth et al. 2004 [39] (9) Discharge planning and patient education with home visits, or telephone follow-up, or clinic follow-up 16 4,440 0.88 (0.79-0.97)
Phillips et al. 2004 [40] (9) Discharge planning with  
   A single home visit 3 476 0.76 (0.63-0.93)
   Home visits / frequent telephone contact 6 970 0.79 (0.69-0.91)
   Extended home care services 4 859 0.82 (0.68-1.00)
   Day Hospital services 1 234 0.25 (0.15-0.44)
McAlister et al. 2004 [41] (6) Multidisciplinary team providing follow-up in a non-clinic setting 8 1,646 0.81 (0.72-0.91)
Gwadry et al. 2004 [42] (7) Patient education and post discharge follow-up at home or by phone 8 1,239 0.79 (0.68-0.91)
Self-management
Kozak et al. 2007 [43] (6) Education for self-management before or after discharge  
   Face-to-face contact 9 1,747 0.42 (0.22-0.81) ++++
   Combined telephone and face to face contact 5 1,253 0.37 (0.21–0.64)++++
Jovicic et al. 2006 [44] (8) Patients assume primary role in managing their health after receiving education before discharge, with limited follow-up phone calls or home visits after discharge 5 787 0.59 (0.44-0.80)
McAlister et al. 2004 [41] (6) Enhanced patient self-care activities 4 568 0.73 (0.57-0.93)
Pharmacist care
Koshman et al. 2008 [45] (8) Pharmacist care in a multidisciplinary team, in hospital or in outpatient clinic, with or without home visits 11 2,026 0.71 (0.54-0.94)
Telemonitoring / structured telephone support
Inglis et al. 2011 [46] (10) Telemonitoring Structured telephone support 8 2,343 0.91 (0.84-0.99)
11 4,295 0.92 (0.85-0.99)
Klersy et al. 2011 [47] (7) Remote monitoring 18 5,312 0.87 (0.79-0.96)
Exercise training
Lloyd-Williams et al. 2002 [48](5) Exercise training 1 99 0.29 (0.11-0.84)
Clinic follow up / telephone contact
Lambrinou et al. 2012 [32] (9) Telephone follow-up 3 634 0.83 (0.66-1.04)
Clinic follow-up 3 944 1.03 (0.75-1.40)
Combination of settings 5 1,422 0.81 (0.64-1.03)
Takeda et al. 2012 [33] (10) Clinic care 4 1,129 0.78 (0.48-1.26)
Kozak et al. 2007 [43] (6) Education for self-management before or after discharge 7 1,671 0.67 (0.36-1.26) ++++
     Telephone contact    
Mistiaen and Poot 2006 [49] (8) Telephone follow-up 2 258 0.67 (0.19-2.33)+
Phillips et al. 2005 [50] (8) Specialist nurse-led clinics:  
     With hospital discharge planning 2 288 0.30 (0.04-2.60)
     No hospital discharge planning 4 661 1.00 (0.86-1.17)
Whellan et al. 2005 [35] (3) Discharge planning and disease management with  
     Follow up with cardiologist supervision 4 825 0.6 (0.3-0.9) +++
       Follow up with primary care physician supervision 2 662 1.2 (0.9-1.5) +++
     Telephone follow up 3 730 0.8 (0.7-0.9) +++
Holland et al. 2005 [37] (8) Multidisciplinary interventions    
Phone/mailing 9 3,349 0.86 (0.73-1.02)
2 1,701  
  Hospital/clinic/general practice    0.99 (0.90-1.10)
Phillips et al. 2004 [40] (9) Comprehensive discharge planning with    
     Clinic follow up / frequent telephone contact 4 765 0.64 (0.32-1.28)
McAlister et al. 2004 [41] (6) Multidisciplinary team providing care    
     In clinic 7 1,183 0.76 (0.58-1.01)
     By telephone follow-up 10 2,923 0.98 (0.80-1.20)
Coronary heart disease
Heran et al. 2011 [51] (10) Exercise-based cardiac rehabilitation    
     Follow-up of 6 to 12 months 4 463 0.69 (0.51-0.93)
     Follow-up of 12 months or more 7 2,009 0.98 (0.87-1.11)
McAlister et al. 2001 [52] (6) Secondary prevention programs 6 4,186 0.84 (0.76-0.94)
Bronchial asthma
McLean et al. 2011 [53] (9) Telehealthcare (personalized care at a distance)  
     Readmissions within 3 months 2 138 0.91 (0.07-12.7)
     Readmissions within 12 months 4 499 0.25 (0.09-0.66)
Tapp et al. 2007 [54] (10) Education interventions for adults who attend the emergency room for acute asthma 5 566 0.50 (0.27-0.91)
Tsai et al. 2005 [34] (6) All types of interventions to improve care for asthma 8 1,876 0.76 (0.60-0.97)+
Gibson et al. 2002 [55] (10) Self-management education of adults with asthma 12 2,418 0.64 (0.50-0.82)
Prevention of falls in older people in the community
Gillespie et al. 2012 [56] (11) Outcome: number of people sustaining fractures:  
     Exercise 5 570 0.72 (0.47-1.11)
     Vitamin D (with or without calcium) 10 27,070 0.94 (0.82-1.09)
     Multifactorial intervention after assessment 11 3,808 0.84 (0.67-1.05)
Beswick et al. 2008 [57] (7) Falls prevention interventions and community based care after hospital discharge 41 20,047 0·94 (0·91–0·97)
Critically ill patients
Kim & Soeken 2005 [38] (7) Inhospital assessment and education with phone follow-up 1 220 0.34 (0.12-0.94)
Stroke
Fearon et al. 2012 [58] (11) Early supported discharge services 7 918 1.26 (0.94-1.67)
Shepperd et al. 2009 [59] (10) Hospital at home early discharge:    
     Patients after a stroke at 3 months 3 179 1.06 (0.47-2.38)
Orthopedic surgery
Handoll et al. 2011 [60] (11) Improving mobility after surgery for hip fractures:    
     Resistance training – at 12 weeks 1 51 0.78 (0.19-3.14)
     Resistance training – at 12 months 1 51 1.39 (0.59-3.43)
     High dose weight bearing (HRR at 16 weeks) 1 150 0.79 (0.35-1.77)
Khan et al. 2008 [61] (9) Home-based multidisciplinary rehabilitation programs after joint replacement in chronic arthropathy 1 172 0.84 (0.33-2.14)
Cancer
Smeenk et al. 1998 [62] (6) Home care for patients with incurable cancer 4 923 0.79 (0.55-1.15)+
Epilepsy
Kim & Soeken 2005 [38] (7) Inhospital assessment and education with phone follow-up 1 42 0.29 (0.07-1.19)
Chronic obstructive pulmonary disease
Jeppesen et al. 2012 [63] (11) Hospital at home for acute exacerbations 8 870 0.76 (0.59-0.99)
Puhan et al. 2011 [64] (9) Respiratory rehabilitation after acute exacerbations 5 250 0.22 (0.08–0.58)
Wong et al. 2011 [10] (11) Nurses visited patients' homes, provided support, education, and monitoring of health. 5 684 1.01 (0.71-1.44)
Lemmens et al. 2009 [65] (7) Disease-management interventions. 4 602 0.64 (0.51-0.81) +
Shepperd et al. 2009b [59] (10) Hospital at home after early discharge 4 357 0.83 (0.61-1.13)
Effing et al. 2007 [66] (11) Self-management education 8 966 0.64 (0.47-0.89)++++
Adams et al. 2007 [67] (7) Chronic Care Model Multicomponent intervention 4 716 0.79 (0.66-0.94)
Self-management 3 325 1.02 (0.66-1.57)
Kim & Soeken 2005 [38] (7) Inhospital assessment and education with phone follow-up 1 66 1.00 (0.02-51.9)
Patients with chronic disease or geriatric patients
Conroy et al. 2011 [68] (9) Comprehensive geriatric assessment at hospital aimed at rapid discharge with varying degrees of community support 5 2,287 0.95 (0.83–1.08)
Vázquez & Martines 2011 [69](6) Inhospital and at home medication reconciliation to prevent adverse events 2 1,259 0.87 (0.63-1.19)
Elkan et al. 2001 [70] (10) Home visiting programs that offer health promotion and preventive care to older people. 6 2,743 0.95 (0.80-1.09)
Shepperd et al. 2009 [59] (10) Hospital at home early discharge: Older patients with a mix of conditions 5 969 1.35 (1.03-1.76)
Shepperd et al. 2009 [71] (8) Avoiding hospital admission through provision of hospital care at home 3 416 1.49 (0.96–2.33)
Latour et al. 2007 [72] (7) Nurse-led case management for ambulatory complex patients in general health care 5 2,395 0.80 (0.60-1.09)+
Kripalani et al. 2007 [73] (5) Interventions to enhance medication adherence 4 670 0.76 (0.38-1.49)+
Royal et al. 2006 [74] (10) Pharmacists-led interventions in primary care to reduce medication related adverse events 9 13,132 0.92 (0.80-1.04)
Kim & Soeken 2005 [38] (7) Inhospital assessment of frail patients with follow up by phone and home visits 3 1,458 0.97 (0.75-1.19)
Parker et al. 2002 [18] (9) Discharge arrangements in hospital and/or in the community after discharge from hospital care.  
     Both in hospital and in the patient’s home 15 * 0.83 (0.69-1.00)
     Patient’s home only 10 * 0.80 (0.61-1.03)
     Patient education and home follow up. 5 * 0.67 (0.57-0.78)
Mitchell et al. 2002 [75] (4) Primary medical practitioner involvement with a specialist team 1 364 1.20 (0.86-1.69)+
Hyde et al. 2000 [76] (6) Supported discharge after acute admission of older patients. Home visits, with or without rehabilitation, commencing 1 week after discharge. 6 916 0.90 (0.77-1.04)+
Stuck et al. 1993 [30] (6) Comprehensive geriatric assessment.  
     Home assessment service 7 5,240 0.84 (0.73-0.96)
     Hospital and home assessment service 3 847 1.03 (0.56-1.90)
     Outpatient assessment service 4 999 1.24 (0.89-1.73)
  1. HRR – Hospital readmission rates. RCT- Randomized controlled trial.
  2. RR – risk ratio. OR – odds ratio. CI – confidence intervals. ER - Referrals to emergency department.
  3. * not given. + Datum not given; recalculated by the authors of the present meta-review.
  4. ++ Risk of sustaining a fracture after falling. +++ Derived from reported figure.
  5. ++++ Readmissions for discharge diagnosis only.