Communication Interventions at Hospital Discharge Found to Reduce Readmissions, Improve Patient-Relevant Outcomes

Communication interventions at hospital discharge significantly reduced hospital readmissions and improved treatment adherence and patient satisfaction, according to findings of an analysis published in JAMA Network Open.

Study authors conducted a systematic review and meta-analysis (PROSPERO Number: CRD42020146415) to evaluate the effect of communication interventions at hospital discharge on patient-relevant outcomes.

Publication databases, including PubMed, EMBASE, PsycINFO, and CINAHL, were searched through February 2021 for studies regarding communication interventions among patients at hospital discharge.

The primary outcome of the analysis was hospital readmission; secondary outcomes were treatment adherence, patient satisfaction, mortality, and emergency department (ED) visit 30 days after hospital discharge.

A total of 60 randomized clinical trials that included 16,070 patients were included in the qualitative synthesis and 19 trials with 3953 patients in the quantitative synthesis. Eligible studies were published between 1981 and 2021, were conducted in 18 countries, and sample sizes ranged between 25 and 3386 participants.

Patients were enrolled as medical in-patients in 24 studies (35%), with a majority focusing on those who were aged 65 years and older; as polymedicated patients in 5 studies (24%); and as ED patients in 13 studies (22%). A total of 13 studies (22%) and 10 studies (17%) enrolled patients in cardiology and patients with respiratory diseases, respectively.

The interventions focused on medication counseling (47%), disease management (45%), or communication strategies (8%), such as encouragement or motivational interviewing.

Compared with usual care, the communication intervention decreased risk for hospital readmission at 30 days (risk ratio [RR], 0.69; 95% CI, 0.56-0.84; I²=9.4%; P =.34). In a subgroup analysis, a significant effect was observed among women (RR, 0.55; 95% CI, 0.39-0.77), patients with respiratory conditions (RR, 0.32; 95% CI, 0.18-0.57), and those with other illnesses (RR, 0.78; 95% CI, 0.64-0.96), but not among men (RR, 0.82; 95% CI, 0.64-1.06) and those with cardiac conditions (RR, 0.62; 95% CI, 0.38-1.02).

Adherence to treatment regimen was increased among patients who received a communication intervention (RR, 1.24; 95% CI, 1.13-1.37; I²=85.3%; P <.001). In the subgroup analysis, communication was effective for older patients (mean age, >65 years; RR, 1.58; 95% CI, 1.08-2.29) and those enrolled as in-patients (RR, 1.42; 95% CI, 1.13-1.78), but not among younger patients (mean age, £65 years; RR, 1.05; 95% CI, 0.97-1.14) and those enrolled from the ED (RR, 1.04; 95% CI, 0.97-1.11).

Communication was associated with increased patient satisfaction (RR, 1.41; 95% CI, 1.20-1.66; I²=91.1%; P <.001).

Study authors noted limited evidence to support the association between communication and 30-day mortality (RR, 0.70; 95% CI, 0.38-1.29; I²=0.0%; P =.79) and ED readmission (RR, 0.86; 95% CI, 0.67-1.10; I²=48.3%; P =.04).

The current analysis was limited by the high heterogeneity among the patient populations and the communication interventions, which may have limited the generalizability of these findings.

Study authors concluded, “Communication interventions at hospital discharge are important to facilitate the transition of care. Thus, health care systems should implement such communication strategies at discharge to facilitate the transition of care.”

Reference

Becker C, Zumbrunn S, Beck K, et al. Interventions to improve communication at hospital discharge and rates of readmission: a systematic review and meta-analysis. JAMA Netw Open. 2021;4(8):e2119346. doi:10.1001/jamanetworkopen.2021.19346