A new systematic review published in Annals of Internal Medicine has cast doubt on the effectiveness of routine post-discharge contact (PDC) interventions, challenging a widely adopted practice in hospital transitional care management.
Key Study Findings
The comprehensive analysis examined 13 studies, including 11 randomized trials, published between 2012 and May 2023. The research focused on PDCs conducted within 7 days of hospital discharge, primarily delivered via telephone contact. The findings revealed no significant impact on key healthcare utilization metrics.
Analysis of 5 randomized trials involving 3,054 patients showed no meaningful reduction in emergency department visits within 30 days post-discharge (risk difference: 0.00; 95% CI, -0.02 to 0.03). Similarly, data from 7 randomized trials encompassing 7,075 patients demonstrated no difference in hospital readmission rates (risk difference: 0.00; 95% CI, -0.02 to 0.02).
Study Characteristics and Methodology
The research spanned multiple geographical regions, with studies conducted across the United States, Europe, Canada, and New Zealand. Eight of the studies specifically targeted high-risk patients, with sample sizes ranging from 25 to 3,054 participants. Most interventions consisted of a single telephone contact within three days of discharge.
The quality assessment revealed varying levels of scientific rigor among the included studies. Three randomized trials demonstrated low risk of bias, while one showed high risk. Both non-randomized studies exhibited serious risk of bias concerns.
Patient Satisfaction and Additional Outcomes
While patient satisfaction was evaluated in four studies involving 3,397 patients, only one small study (n=60) reported significantly higher satisfaction rates in the PDC group. Four studies examining composite outcomes of unplanned healthcare use, including both readmissions and ED visits, found no significant differences between intervention and control groups.
Implications for Healthcare Practice
The findings suggest that the current widespread implementation of universal PDCs may need reconsideration, particularly for lower-risk patients. The study authors emphasize the potential value of developing more targeted, multifaceted approaches for high-risk populations who may benefit from more comprehensive intervention strategies.
Study Limitations
The researchers acknowledged several limitations in their analysis, including:
- Poor documentation of adherence to PDC protocols
- Limited exploration of non-telephone contact methods
- Variable certainty of evidence across studies
- Insufficient focus on high-risk patient populations
The results of this systematic review prompt a critical reassessment of current transitional care practices and suggest the need for more sophisticated, risk-stratified approaches to post-discharge care management.
