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Results for 'hospital readmission'

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Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews

DAMERY Sarah, FLANAGAN Sarah, COMBES Gill
2016

Objective: To summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity. Design: Umbrella review of systematic reviews and meta-analyses. Setting: Interventions must have delivered care crossing the boundary between at least two health and/or social care settings. Participants: Adult patients with one or more chronic diseases. Data sources: MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (HTA database,DARE, Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, HEED, manual screening of references. Outcome measures: Any measure of hospital admission or readmission, length of stay (LoS), accident and emergency use, healthcare costs. Results: 50 reviews were included. Interventions focused on case management (n=8), chronic care model (CCM) (n=9), discharge management (n=15), complex interventions (n=3), multidisciplinary teams (MDT) (n=10) and self-management (n=5). 29 reviews reported statistically significant improvements in at least one outcome. 11/21 reviews reported significantly reduced emergency admissions (15–50%); 11/24 showed significant reductions in all-cause (10–30%) or condition-specific (15–50%) readmissions; 9/16 reported LoS reductions of 1–7 days and 4/9 showed significantly lower A&E use (30–40%). 10/25 reviews reported significant cost reductions but provided little robust evidence. Effective interventions included discharge management with post-discharge support, MDT care with teams that include condition-specific expertise, specialist nurses and/or pharmacists and self-management as an adjunct to broader interventions. Interventions were most effective when targeting single conditions such as heart failure, and when care was provided in patients’ homes. Conclusions: Although all outcomes showed some significant reductions, and a number of potentially effective interventions were found, interventions rarely demonstrated unequivocally positive effects. Despite the centrality of integrated care to current policy, questions remain about whether the magnitude of potentially achievable gains is enough to satisfy national targets for reductions in hospital activity.

Avoiding unhappy returns: radical reductions in readmissions, achieved with volunteers

ROYAL VOLUNTARY SERVICE
2014

A summary of the achievements of the Royal Voluntary Service Hospital 2 Home service during its first year. Leicestershire County Council launched the scheme in hospitals in six districts, including the three university hospitals in Leicester in summer 2012. The service provides practical help and support following a discharge from hospital; helps users to regain confidence and reduce anxiety; reduces social isolation; promotes independent living and choice; helps users to maintain day to day activities; provides information/signpost to other organisations; and helps prevent readmissions to hospital. Designed to be short-term, friendly and confidential and people-centred, the service is provided free of charge and is normally available for up to six weeks. Over 600 people have been referred. Among the participants readmission rates to hospital have been very low, with readmissions of older people approximately half national rates.

Results 1 - 2 of 2

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