Intervention Review

Discharge planning from hospital to home

  1. Sasha Shepperd1,*,
  2. Jacqueline McClaran2,
  3. Christopher O Phillips3,
  4. Natasha A Lannin4,
  5. Lindy M Clemson5,
  6. Annie McCluskey6,
  7. Ian D Cameron7,
  8. Sarah L Barras8

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 25 MAR 2009

DOI: 10.1002/14651858.CD000313.pub3

Database Title

Additional Information

How to Cite

Shepperd S, McClaran J, Phillips CO, Lannin NA, Clemson LM, McCluskey A, Cameron ID, Barras SL. Discharge planning from hospital to home. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD000313. DOI: 10.1002/14651858.CD000313.pub3.

Author Information

  1. 1

    University of Oxford, Department of Public Health, Oxford, Oxfordshire, UK

  2. 2

    Oxford Radcliffe Hospitals Trust, Medical School, Oxford, UK

  3. 3

    Morehouse School of Medicine, Atlanta, Georgia, USA

  4. 4

    Northern Clinical School, Sydney Medical School, The University of Sydney, Rehabilitation Studies Unit, Ryde, NSW, Australia

  5. 5

    University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia

  6. 6

    Faculty of Health Sciences, The University of Sydney, Community Based Health Care Research Unit, Sydney, New South Wales, Australia

  7. 7

    Sydney Medical School, The University of Sydney, Rehabilitation Studies Unit, Northern Clinical School, Ryde, NSW, Australia

  8. 8

    Ramsay Healthcare, Donvale Rehabilitation Occupational Therapy Department, Melbourne, Vic, Australia

*Sasha Shepperd, Department of Public Health, University of Oxford, Rosemary Rue Building, Headington, Oxford, Oxfordshire, OX3 7LF, UK. Sasha.Shepperd@dphpc.ox.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 20 JAN 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Discharge planning is a routine feature of health systems in many countries. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and improve the co-ordination of services following discharge from hospital.

Objectives

To determine the effectiveness of planning the discharge of patients moving from hospital.

Search methods

We updated the review using the Cochrane EPOC Group Trials Register, MEDLINE, EMBASE and the Social Science Citation Index (last searched in March 2009).

Selection criteria

Randomised controlled trials (RCTs) that compared an individualised discharge plan with routine discharge care that was not tailored to the individual patient. Participants were hospital inpatients.

Data collection and analysis

Two authors independently undertook data analysis and quality assessment using a predesigned data extraction sheet. Studies are grouped according to patient group (elderly medical patients, surgical patients and those with a mix of conditions) and by outcome.

Main results

Twenty-one RCTs (7234 patients) are included; ten of these were identified in this update. Fourteen trials recruited patients with a medical condition (4509 patients), four recruited patients with a mix of medical and surgical conditions (2225 patients), one recruited patients from a psychiatric hospital (343 patients), one from both a psychiatric hospital and from a general hospital (97 patients), and the final trial recruited patients admitted to hospital following a fall (60 patients). Hospital length of stay and readmissions to hospital were significantly reduced for patients allocated to discharge planning (mean difference length of stay -0.91, 95% CI -1.55 to -0.27, 10 trials; readmission rates RR 0.85, 95% CI 0.74 to 0.97, 11 trials). For elderly patients with a medical condition (usually heart failure) there was insufficient evidence for a difference in mortality (RR 1.04, 95% CI 0.74 to 1.46, four trials) or being discharged from hospital to home (RR 1.03, 95% CI 0.93 to 1.14, two trials). This was also the case for trials recruiting patients recovering from surgery and a mix of medical and surgical conditions. In three trials patients allocated to discharge planning reported increased satisfaction. There was little evidence on overall healthcare costs.

Authors' conclusions

The evidence suggests that a structured discharge plan tailored to the individual patient probably brings about small reductions in hospital length of stay and readmission rates for older people admitted to hospital with a medical condition. The impact of discharge planning on mortality, health outcomes and cost remains uncertain.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Discharge planning from hospital to home

Discharge planning is the development of an individualised discharge plan for the patient prior to leaving hospital, with the aim of containing costs and improving patient outcomes. Discharge planning should ensure that patients are discharged from hospital at an appropriate time in their care and that, with adequate notice, the provision of other services will be organised.

A review of the effects of different discharge plans was conducted. After searching for relevant studies, 21 studies were found which compared discharge plans tailored to the individual patients with routine discharge care that was not individualised.

This review indicates that a structured discharge plan tailored to the individual patient probably brings about a small reduction in hospital length of stay and readmission rates, and an increase in patient satisfaction. The impact on health outcomes is uncertain.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

從醫院返家之出院規劃

在許多國家的健康照護系統中，出院規劃是一種常規。其目的是減少住院天數及非計畫的再入院，並增進出院後統籌協調的服務，藉此縮小住院與出院後的差距。有時提供出院規劃為整合套裝照護的一部分，它可以涵蓋醫院與社區的範圍。這篇回顧的重點是有關病人住院中之出院規劃；我們排除包括後續服務之出院規劃的研究。

目標

確定出院規劃的效果。

搜尋策略

我們使用Cochrane EPOC Group Trials Register、MEDLINE、EMBASE 及Social Science Citation Index 更新本篇回顧(最後搜尋日期為last 2009年3月)。

選擇標準

研究設計：比較出院規劃(發展一種個人化的出院計畫)與例行出院照護之隨機對照試驗(randomised controlled trials (RCTs))。研究對象：住院中的所有病患。介入措施：發展一種個人化的出院計畫。

資料收集與分析

由兩位回顧者採用資料確認表分別進行資料分析及品質評估。依據病人群組(老年的醫療病患，手術病患，及混合狀況的病患)及健康結果將研究分類。

主要結論

這次更新納入三篇新的研究。我們總共納入11篇隨機對照試驗：6篇試驗納入具有醫療狀況的病患(2,368名病患)，及四篇納入合併醫療及手術狀況的病患(2,983名病患)，這四篇中有一篇將納入的醫療及手術病患視為分開的群組，最後一篇試驗納入來自精神醫院與綜合醫院的97名病患。我們發現具有醫療狀況之老年患者其死亡率(OR 1.44 95% CI 0.82 to 2.51)，住院天數(weighted mean difference 0.86, 95% CI −1.9 to 0.18)，再入院率(OR 0.91 95% CI 0.67 to 1.23)及出院回家(OR 1.15 95% CI 0.72 to 1.82)並無群組間之差異。同樣的情形也發生在從手術復原病患的試驗及合併醫療與手術狀況病患的試驗。一篇試驗比較結構性途徑的照護與多科別照護對於中風病患的康復，試驗報告顯示對照組在功能活動及生活品質有顯著的進步(4至12週間，治療組其巴氏量表分數(Barthel scores)的中位數改變兩分，相較對照組改變6分，p<0.01)；(6個月時治療組的Euroqol分數為63分，對照組為72分，p<0.005)。有兩篇試驗報告指出，相較於接受例行出院照護者，分配至出院規劃的醫療病患其滿意度增加。整體的健康照護成本則沒有統計上的顯著差異。

作者結論

出院規劃對於再入院率，住院天數，健康結果與成本的影響不明確。這反映出統計檢定力(power)的缺乏，因為我們可以加總資料的程度受限於不同的測量結果。即使住院天數或再住院率少量的減少，仍有可能影響日後住院量，特別是針對缺乏急性病床的醫療系統。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

出院規劃對於病患之再住院率，住院天數，健康結果及成本(病患與健康照護提供者)的影響是不明確的。出院規劃是針對病患在離院前發展一個出院計畫，其目的是維持成本且增進病患的恢復結果。發展出院計畫逐漸成為整合式套裝照護的一部分，使單獨研究出院規劃是困難的。雖然出院規劃的影響也許很小，但也可能因為少量的住院天數或再入院率減少，可以使急性病床短缺的健康照護系統騰出容量以供日後的住院患者使用。

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