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Pediatric hospital discharge interventions to reduce subsequent utilization: A systematic review

Authors

  • Katherine A. Auger MD, MSc,

    Corresponding author
    1. Department of Pediatrics, Division of Hospital Medicine, James M. Anderson Center for Health Care Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
    • Address for correspondence and reprint requests: Katherine Auger, MD, 3333 Burnet Ave., MLC 9016; Cincinnati, OH 45229; Telephone: 513–636-3753; Fax: 513-636-4402; E-mail: katherine.auger@cchmc.org

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  • Chén C. Kenyon MD, MSHP,

    1. Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Chris Feudtner MD, PhD, MPH,

    1. Department of Pediatrics, Division of General Pediatrics, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Matthew M. Davis MD, MAPP

    1. Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, Department of Internal Medicine, Institute for Healthcare Policy and Innovation, Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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Abstract

BACKGROUND

Reducing avoidable readmission and posthospitalization emergency department (ED) utilization has become a focus of quality-of-care measures and initiatives. For pediatric patients, no systematic efforts have assessed the evidence for interventions to reduce these events.

PURPOSE

We sought to synthesize existing evidence on pediatric discharge practices and interventions to reduce hospital readmission and posthospitalization ED utilization.

DATA SOURCES

PubMed and the Cumulative Index to Nursing and Allied Health Literature.

STUDY SELECTION

Studies available in English involving pediatric inpatient discharge interventions with at least 1 outcome of interest were included.

DATA EXTRACTION

We utilized a modified Cochrane Good Practice data extraction tool and assessed study quality with the Downs and Black tool.

DATA SYNTHESIS

Our search identified a total of 1296 studies, 14 of which met full inclusion criteria. All included studies examined multifaceted discharge interventions initiated in the inpatient setting. Overall, 2 studies demonstrated statistically significant reductions in both readmissions and subsequent ED visits, 4 studies demonstrated statistically significant reductions in either readmissions or ED visits, and 2 studies found statistically significant increases in subsequent utilization. Several studies were not sufficiently powered to detect changes in either subsequent utilization outcome measure.

CONCLUSIONS

Interventions that demonstrated reductions in subsequent utilization targeted children with specific chronic conditions, providing enhanced inpatient feedback and education reinforced with postdischarge support. Interventions seeking to reduce subsequent utilization should identify an individual or team to assume responsibility for the inpatient-to-outpatient transition and offer ongoing support to the family via telephone or home visitation following discharge. Journal of Hospital Medicine 2014;9:251–260. © 2013 Society of Hospital Medicine

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