Hospital Discharge Planning—An Investigation of Outcomes and Interventions
这篇伞状综述汇总了34篇系统综述，发现出院计划与降低再入院率、减少用药差错和提高患者满意度有强证据关联，但对生活质量、急诊就诊等效果证据不足。
OBJECTIVE: To provide a comprehensive overview of the different types of hospital discharge planning (DP) interventions and outcomes examined in systematic reviews, and to assess the strength of evidence (SoE) for the associations between DP and these outcomes. STUDY SETTING AND DESIGN: Umbrella review ("review of systematic reviews"). DATA SOURCES: We searched five databases (PubMed, CINAHL, Web of Science, Cochrane, and Business Source Complete) from inception through February 2024 for systematic reviews examining associations between hospital DP and various outcomes. We conducted backward and forward citation searches to identify additional systematic reviews. Altogether, these searches yielded 1817 records, of which 34 met the inclusion criteria. We assessed the methodological quality of the included reviews using the AMSTAR 2 tool, summarized DP intervention types and the reviews' subgroup analyses narratively, and evaluated the SoE for 19 outcomes using a recently developed method. PRINCIPAL FINDINGS: We identified 20 distinct DP intervention types which we grouped into six intervention categories. Patient education was the most frequently investigated type. We rated SoE as high for five outcomes, moderate for eight, and low for six. We found the strongest evidence for associations between hospital DP and reduced readmissions, fewer medication discrepancies, and greater patient satisfaction. Evidence for associations with quality of life, emergency department visits, mortality, and overall patient health, however, was weak or lacking. Our synthesis of the reviews' subgroup analyses indicated that the effects of hospital DP varied across patient populations and intervention types. Overall, the most effective interventions appeared to be high-intensity, bundled programs, incorporating medication-related interventions and follow-ups, particularly for reducing readmissions. CONCLUSION: This umbrella review synthesizes evidence on associations between hospital DP and various outcomes. The findings support the development of tailored DP strategies and point to research gaps. Future studies should prioritize standardizing intervention definitions, outcome measures, and subgroup classifications, and investigate unexamined causal mechanisms.