Key result
Integrating primary care into transitional aftercare cuts 30-day readmissions ~32% in older patients.
Why the study?
Quality aftercare impacts older patients health status, but evidence on the effectiveness of primary healthcare in supporting aftercare after hospital discharge is limited.
Does the integration of primary healthcare into transitional aftercare reduce hospital readmission rates and improve health status in older patients after hospital discharge?
Meta-Analysis (n=11,693)
Does the integration of primary healthcare into transitional aftercare reduce hospital readmission rates and improve health status in older patients after hospital discharge?
Integrating primary healthcare into post-discharge transitional care significantly reduces both 30-day and 6-month hospital readmission rates for older adults and appears cost-effective.
BACKGROUND: Quality of aftercare can crucially impact health status of older patients and reduce the extra burden of unplanned healthcare resource utilisation. However, evidence of effectiveness of primary healthcare in supporting aftercare, especially for older patients after discharge are limited. METHODS: We searched for English articles of randomised controlled trials published between January 2000 and March 2022. All-cause hospital readmission rate and length of hospital stay were pooled using a random-effects model. Subgroup analyses were conducted to identify the relationship between intervention characteristics and the effectiveness on all-cause hospital readmission rate. RESULTS: A total of 30 studies with 11,693 older patients were included in the review. Compared with patients in the control group, patients in the intervention group had 32% less risk of hospital readmission within 30 days (RR = 0.68, P < 0.001, 95%CI: 0.56-0.84), and 17% within 6 months (RR = 0.83, P < 0.001, 95%CI: 0.75-0.92). According to the subgroup analysis, continuity of involvement of primary healthcare in aftercare had significant effect with hospital readmission rates (P < 0.001). Economic evaluations from included studies suggested that aftercare intervention was cost-effective due to the reduction in hospital readmission rate and risk of further complications. CONCLUSION: Integrating primary healthcare into aftercare was designed not only to improve the immediate transition that older patients faced but also to provide them with knowledge and skills to manage future health problems. There is a pressing need to introduce interventions at the primary healthcare level to support long-term care.
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Li et al. (2022) conducted a meta-analysis in Older adults hospitalized for chronic diseases (n=11,693). Integration of primary healthcare into transitional aftercare vs. Standard procedures for discharge and aftercare (treatment-as-usual) was evaluated on All-cause hospital readmission rate within 30 days (RR 0.68, 95% CI 0.56-0.84, p=<0.001). Integrating primary healthcare into transitional aftercare significantly reduced the risk of 30-day hospital readmission by 32% (RR 0.68) compared to standard care in older patients.
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