Electronic Health Record Interventions to Reduce Risk of Hospital Readmissions

Importance Hospital readmissions are associated with significant health care costs and poor patient outcomes. Despite the rapid adoption of electronic health record (EHR) systems, the use of EHR-based interventions to reduce the risk of hospital readmissions is unknown. Objective To systematically review and estimate the association of EHR-based interventions vs controls with preventing 30-day all-cause hospital readmissions as tested in randomized clinical trials (RCTs). Data Sources Ovid MEDLINE, Ovid Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from database inception to July 5, 2024, using text words with analogous terms within concept areas of “randomized controlled trial,” “hospitalized adults,” and “readmissions.” Study Selection RCTs were included if they evaluated the effect of EHR-based interventions on hospital readmissions compared with a control arm without an EHR-embedded component. Studies were excluded if they involved nonhospitalized, pediatric, obstetric, or psychiatric populations or did not report readmission outcomes. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Data Extraction and Synthesis Data were extracted independently by 3 reviewers in duplicate. A random-effects model was used to pool data, and the quality of studies was assessed using the Cochrane Risk of Bias tool. Heterogeneity was quantified using the I 2 statistic and explored with prespecified subgroup analyses and univariable meta-regression by population demographics, intervention complexity, and publication year. Main Outcomes and Measures The primary outcome was 30-day all-cause hospital readmission, and other readmission outcomes (eg, unplanned readmissions and readmissions at 3, 6, 12, and 24 months) were examined as secondary outcomes. Results A total of 116 RCTs involving 204 523 participants (weighted mean SD males, 56% 16%; weighted mean SD age, 68 9 years) were included, with telemonitoring (76 studies 66%) being the most common EHR-based intervention component followed by case management (45 studies 39%) and medication reconciliation (33 28%). EHR-based interventions were associated with a statistically significant reduction in 30-day all-cause readmissions (OR, 0.83 95% CI, 0.70-0.99; I 2 = 82%; τ = 0.44 95% CI, 0.30-0.62; prediction interval PI, 0.34-2.06) and 90-day all-cause readmissions (OR, 0.72 95% CI, 0.54-0.96; I 2 = 78%; τ = 0.34 95% CI, 0.19-1.00; PI, 0.33-1.55) compared with control arms. Conclusions and Relevance In this systematic review and meta-analysis of RCTs, the use of EHR-based interventions was associated with a reduction in 30-day and 90-day hospital readmissions. Future research should examine additional components of EHR interventions to understand and account for remaining gaps in effectiveness.