Discharge planning from hospital

Daniela C. Gonçalves‐Bradley; Natasha A Lannin; Lindy M Clemson; Ian D Cameron; Sasha Shepperd

doi:10.1002/14651858.CD000313.pub5

Cochrane Database of Systematic Reviews

Planificación del alta del hospital

Información

DOI:

https://doi.org/10.1002/14651858.CD000313.pub5 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

27 enero 2016see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Práctica y organización sanitaria efectivas

Copyright:

Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

Daniela C. Gonçalves‐Bradley

Nuffield Department of Population Health, University of Oxford, Oxford, UK
Natasha A Lannin

Occupational Therapy, Alfred Health, Prahran, Australia
Lindy M Clemson

Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
Ian D Cameron

John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia
Sasha Shepperd

Correspondencia a: Nuffield Department of Population Health, University of Oxford, Oxford, UK

[email protected]

Contributions of authors

Daniela Gonҫalves‐Bradley (DCGB) scanned the abstracts and extracted data for this update and took the lead in analysing the data and updating the text of the review. Natasha Lannin (NL), Lindy Clemson (LC) and Ian Cameron (IC) scanned the abstracts and extracted data. Sasha Shepperd (SS) co‐authored the protocol for the review with Julie Parkes (no longer an author), extracted and analysed data for previous versions of this review, and led the writing of the review.

Sources of support

Internal sources

Anglia and Oxford Regional Research and Development Programme, UK.

External sources

NIHR Evidence Synthesis Award to SS and NHS Cochrane Collaboration Programme Grant Scheme, UK.
NIHR Evidence Synthesis Award; and an NIHR Cochrane Programme grant for the last two updates., UK.

Declarations of interest

DCGB: none known.
NL: none known.
LC: none known.
IC: none known.
SS: none known.

Acknowledgements

Diana Harwood for assisting in scanning abstracts retrieved from electronic searches for the original review; Andy Oxman for commenting on all versions of this review; Jeremy Grimshaw and Darryl Wieland for helpful comments on earlier drafts and Luciana Ballini, Tomas Pantoja, Craig Ramsey, Darryl Weiland and Kirsten Woodend for comments on the previous update; Nia Roberts for conducting the literature searches; and Julie Parkes, Christopher Phillips, Jacqueline McClaran, Sarah Barras, and Annie McCluskey for contributing to previous versions of this review (Parkes 2000; Shepperd 2010, Shepperd 2013).

Version history

Published

Title

Stage

Authors

Version

2022 Feb 24

Discharge planning from hospital

Review

Daniela C Gonçalves-Bradley, Natasha A Lannin, Lindy Clemson, Ian D Cameron, Sasha Shepperd

https://doi.org/10.1002/14651858.CD000313.pub6

2016 Jan 27

Discharge planning from hospital

Review

Daniela C. Gonçalves‐Bradley, Natasha A Lannin, Lindy M Clemson, Ian D Cameron, Sasha Shepperd

https://doi.org/10.1002/14651858.CD000313.pub5

2013 Jan 31

Discharge planning from hospital to home

Review

Sasha Shepperd, Natasha A Lannin, Lindy M Clemson, Annie McCluskey, Ian D Cameron, Sarah L Barras

https://doi.org/10.1002/14651858.CD000313.pub4

2010 Jan 20

Discharge planning from hospital to home

Review

Sasha Shepperd, Jacqueline McClaran, Christopher O Phillips, Natasha A Lannin, Lindy M Clemson, Annie McCluskey, Ian D Cameron, Sarah L Barras

https://doi.org/10.1002/14651858.CD000313.pub3

2004 Jan 26

Discharge planning from hospital to home

Review

Sasha Shepperd, Julie Parkes, Jacqueline JM McClaran, Christopher Phillips

https://doi.org/10.1002/14651858.CD000313.pub2

2000 Aug 17

Discharge planning from hospital to home

Review

J Parkes, Sasha S Shepperd

https://doi.org/10.1002/14651858.CD000313

Differences between protocol and review

We performed post hoc subgroup analyses for patients admitted to hospital following a fall and patients admitted to a mental health setting. We performed a post hoc sensitivity analysis by imputing a missing standard deviation for one trial. We made a post hoc decision to exclude studies that were considered to be methodologically weak. We added new analysis to the summary of findings table by including results for the patients admitted to hospital following a fall, patients and healthcare professionals satisfaction, and costs. We merged the outcome "Psychological health of patients" with the outcome "Patient health status".

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

PRISMA flow diagram

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Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Analysis 1.1

Comparison 1 Effect of discharge planning on hospital length of stay, Outcome 1 Hospital length of stay ‐ older patients with a medical condition.

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Analysis 1.2

Comparison 1 Effect of discharge planning on hospital length of stay, Outcome 2 Sensitivity analysis imputing missing SD for Kennedy trial.

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Analysis 1.3

Comparison 1 Effect of discharge planning on hospital length of stay, Outcome 3 Hospital length of stay ‐ older surgical patients.

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Analysis 1.4

Comparison 1 Effect of discharge planning on hospital length of stay, Outcome 4 Hospital length of stay ‐ older medical and surgical patients.

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Analysis 2.1

Comparison 2 Effect of discharge planning on unscheduled readmission rates, Outcome 1 Within 3 months of discharge from hospital.

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Study

Readmission rates

Notes

Evans 1993

At 4 weeks:
T = 103/417 (24%), C = 147/418 (35%)
Difference − 10.5%; 95% CI − 16.6% to − 4.3%, P < 0.001

At 9 months:
T = 229/417 (55%), C = 254/418 (61%)
Difference − 5.8%; 95% CI −12.5% to 0.84%, P = 0.08

—

Analysis 2.2

Comparison 2 Effect of discharge planning on unscheduled readmission rates, Outcome 2 Patients with medical or surgical condition.


Study	Readmissions	Mean time to readmission
Naji 1999	At 6 months: T = 33/168 (19.6%), C = 48/175 (27%) Difference 7.4%; 95% CI − 1.1% to 16.7%	Mean time to readmission T = 161 d, C = 153 d


Study	Days in hospital	Notes
Naylor 1994	Medical readmission days 2 weeks: T = 21 d (n = 72), C = 73 d (n = 70) Difference − 52 d; 95% CI − 78 to − 26 2 to 6 weeks: T = 16 d (n = 72), C = 49 d (n = 70) Difference − 33 d; 95% CI − 53 to − 13 6 to 12 weeks: T = 94 d (n = 72), C = 100 d (n = 70) Difference − 6 d; 95% CI − 83 to 71
Weinberger 1996	Medical readmission days at 6 months follow up: T = 10.2 (19.8), C = 8.8 (19.7) difference 1.4 d, P = 0.04	—


Study	Place of discharge	Notes
Goldman 2014	Discharged to an institutional setting: T = 19/347 (5.5%), C = 9/352 (2.6%) Difference 2.9%; 95% CI − 0.04% to 6%	—
Kennedy 1987	At 2 weeks: 87% no change in placement from time of discharge to 2‐week follow‐up time (both groups) At 4 weeks: majority no change (both groups)	No data shown
Legrain 2011	Discharged home or to a nursing home: T = 183/317 C = 191/348	—
Lindpaintner 2013	Discharged home T = 25/30 (83%), C = 30/30 (100%) Difference 17%, 95% CI 2 to 34%	—
Moher 1992	Discharged home: T = 111/136 (82%), C = 104/131 (79%) Difference 2.2%; 95% CI − 7.3% to 11.7%	—
Naughton 1994	Discharged to nursing home: T = 3/51 (5.9%) C = 2/60 (3.3%) Difference 2.5%; 95% CI − 5.3% to 10.4%	—
Sulch 2000	Discharged home: T = 56/76 (74%), C = 54/76 (71%) Discharged to an institution: T = 10/76 (13%), C = 16/76 (21%) OR 1.5; 95% CI 0.5 to 2.8	—


Study	Mortality at 9 months	Notes
Evans 1993	T = 66/417 (16%) C = 67/418 (16%)	—


Study	Patient health outcomes	Notes
Harrison 2002	SF‐36 Baseline Physical component T = 28.63 (SD 9.46) N = 78 C = 28.35 (SD 9.11) N = 78 Mental component T = 50.49 (SD 12.45) N = 78 C = 49.81 (SD 11.36) N = 78 At 12 weeks Physical component T = 32.05 (SD 11.81) N = 77 C = 28.31 (SD 10.0) N = 74 Mental component T = 53.94 (SD 12.32) N = 78 C = 51.03 (SD 11.51) N = 78 Minnesota Living with Heart Failure Questionnaire (MLHFQ) At 12 week follow‐up (See table 4) n, % Worse: T = 6/79 (8), C = 22/76 (29) Same: T = 7/79 (9), C = 10/76 (13) Better: T = 65/79 (83), C = 44/76 (58)	SF‐36 a higher score indicates better health status MLHFQ a lower score indicates less disability from symptoms
Kennedy 1987	Long Term Care Information System (LTCIS) Health and functional status (also measures services required)	No data reported
Lainscak 2013	St. George’s Respiratory Questionnaire (SGRQ) Change from 7 to 180 d after discharge T = 1.06 (95% CI 9.50 to 8.43), C = − 0.11 (95% CI − 11.34 to 8.12)	Complete data available for only approximately half of the patients. For the SGRQ, higher scores indicate more limitations; minimal clinically important difference estimated as 4 points.
Naylor 1994	Data aggregated for both groups. Mean Enforced Social Dependency Scale increased from 19.6 to 26.3 P < 0.01	No data reported for each group. Decline in functional status reported for all patients. Functional status. Scale measured: Mental status Perception of health Self‐esteem Affect Not possible to calculate exact P value
Nazareth 2001	General well‐being questionnaire: 1 = ill health, 5 = good health At 3 months: T = 76, mean 2.4 (SD 0.7) C = 73, mean 2.4 (SD 0.6) At 6 months: T = 62, mean 2.5 (SD 0.6) C = 61, mean 2.4 (SD 0.7) Mean difference 0.10; 95% CI − 0.14 to 0.34	—
Preen 2005	SF‐12 (N not reported for follow‐up) Mental component score Predischarge score: T = 37.4 SD 5.4 C = 39.8 SD 6.1 7 d postdischarge: T = 42.4 SD 5.6 C = 40.9 SD 5.7 Physical component score Predischarge score: T = 27.8 SD 4.8 C = 28.3 SD 4.7 7 d postdischarge: T = 27.2 SD 4.5 C = 27.2 SD 4.1	—
Rich 1995a	Chronic Heart Failure Questionnaire Treatment N = 67, Control N = 59 Total score At baseline: T = 72.1 (15.6), C = 74.4 (16.3) At 90 d: T = 94.3 (21.3), C = 85.7 (19.0) Change score = 22.1 (20.8), P = 0.001 Dyspnoea At baseline: T = 9.0 (7.9), C = 8.1 (7.7) At 90 d: T = 15.8 (12.8), C = 11.9 (10.0) Change score 6.8 (7.9) Fatigue At baseline: T = 12.9 (5.3), C = 14.1 (5.6) At 90 d: T = 18.3 (6.3), C = 16.8 (5.5) Change score 5.4 (5.5) Emotional function At baseline: T = 31.9 (8.5), C = 33.3 (8.1) At 90 d: T = 37.4 (7.8), C = 35.2 (8.4) Change score 5.6 (7.1) Environmental mastery At baseline: T = 18.3 (5.8), C = 18.9 (4.8) At 90 d: T = 22.7 (4.9), C = 21.7 (4.6) Change score 4.4 (5.3)	Chronic Heart Failure Questionnaire contains 20 questions that the patient is asked to rate on a scale 1 to 7 with a low score indicating poor quality of life
Sulch 2000	Barthel activities of daily living Median scores At 4 weeks: T = 13, C = 11 At 12 weeks: T = 15, C = 17 At 26 weeks: T = 17, C = 17 Median change from 4 to 12 weeks: P < 0.01 Rankin score Median score At 4 weeks: T = 1, C = 1 At 12 weeks: T = 3, C = 3 At 26 weeks: T = 3, C = 3 Hospital anxiety and depression scale Anxiety Median scores At 4 weeks: T = 5, C = 5 At 12 weeks: T = 4, C = 4 At 26 weeks T = 4, C = 4 Depression Median scores At 4 weeks: T = 6, C = 5 At 12 weeks: T = 5, C = 5 At 26 weeks: T = 5, C = 5 EuroQol At 4 weeks: T = 41, C = 44 Median scores At 4 weeks: T = 41, C = 44 P = 0.10 At 12 weeks: T = 59, C = 65 P = 0.07 At 26 weeks: T = 63, C = 72 P < 0.005	The Barthel ADL Index covers activities of daily living; scores range from 0 to 20, with higher scores indicating better functioning. The Rankin scale assesses activities of daily living in people who have had a stroke; it contains 7 items with scores ranging from 0 to 6. Higher scores indicating more disability. The Hospital Anxiety and Depression Scale is a 14‐item Likert scale (0‐3); scores range from 0 to 21 for each subscale (anxiety and depression), with higher scores indicating more burden from symptoms. The EuroQol contains 5 items; higher scores indicate better self‐perceived health status. Not possible to calculate exact P value
Weinberger 1996	At 1 month: no significant differences P = 0.99 At 3 months: no significant differences P = 0.53	SF‐36 No data shown


Study	Satisfaction	Notes
Patient and care givers' satisfaction
Laramee 2003	Mean hospital care: T = 4.2 (N = 120), C = 4.0 (N = 100), P = 0.003 Mean hospital discharge: T = 4.3 (N = 120), C = 4.0 (N = 100), P < 0.001 Mean care instructions: T = 4.0 (N = 120), C = 3.4 (N = 100), P < 0.001 Mean recovering at home: T = 4.4 (N = 120), C = 3.9 (N = 100), P < 0.001 Mean total score: T = 4.2 (N = 120), C = 3.8 (N = 100), P < 0.001	—
Lindpaintner 2013	Satisfaction with discharge process At 5 d (median and IQR) Patients: T = 1 (0), C = 1 (1‐2) Carers: T = 1 (0), C = 1 (1‐2) At 30 d Patients: T = 1 (1‐2), C = 1 (1‐2) Carers: T = 1 (1‐2), C = 2 (1‐3)	4‐point Likert‐scale, lower scores indicate higher satisfaction
Moher 1992	Satisfied with medical care: T = 89%, C = 62% Difference 27%; 95% CI 2% to 52%, P < 0.001	"Please rate how satisfied you were with the care you received…" Subgroup of 40 patients, responses from 18 in the treatment group and 21 in the control group
Nazareth 2001	Client satisfaction questionnaire score (1 = dissatisfied, 4 = satisfied) At 3 months: T = 76, mean 3.3 (SD 0.6) C = 73, mean 3.3 (SD 0.6) At 6 months: T = 62, mean 3.4 (SD 0.6) C = 61, mean 3.2 (SD 0.6) Mean difference 0.20; 95% CI − 0.56 to 0.96
Weinberger 1996	At 1 month: Treatment group more satisfied, P < 0.001 At 6 months: Treatment group more satisfied, P < 0.001 Authors report differences were greatest for patients' perceptions of continuity of care and non‐financial access to medical care	Patient Satisfaction Questionnaire, 11 domains with a 5‐point scale
Professional's satisfaction
Bolas 2004	Standard of information at discharge improved GPs: 57% agreed Community pharmacists: 95% agreed	Response rate of 55% (GPs) and 56% (community pharmacists) No information provided about the survey
Lindpaintner 2013	Satisfaction with discharge process At 5 d (median and IQR) Primary care physician: T = 1 (1‐2), C = 2 (1‐3) Visiting nurse: T = 1 (1‐2), C = 2 (1‐4) At 30 d (median and IQR) Primary care physician: T = 2 (1‐3), C = 1 (1‐2)	Number of respondents ranged between 15 (visiting nurse) and 30 (PCP) 4‐point Likert scale, lower scores indicate higher satisfaction


Study	Costs	Notes
Gillespie 2009	Total T: USD 12000; C: USD 12500 Mean difference: − USD 400 (− USD 4000 to USD 3200) Visits to ED T: USD 160; C: USD 260 Mean difference: − USD 100 (− USD 220 to − USD 10) Readmissions T: USD 12000; C: USD 12300 Mean difference: − USD 300 (− USD 3900 to USD 3300)	Costs calculated for 2008
Laramee 2003	Total inpatient and outpatient median costs T = USD 15,979 C = USD 18,662 P = 0.14	The case manager (CM) kept a log during the first, middle and last 4 weeks of the recruitment period of how much time was spent with each patient during the 12‐week study period. Thus, the average cost of the intervention was calculated based on an hourly wage (including benefits) of USD 33.93 for the CM. The average intervention cost per patient was USD 228.52, and the average time spent with each intervention patient was 6.7 h per 12 weeks.
Naughton 1994	—	Number: T = 51, C = 60 Total cost of hospital care including breakdown of costs for laboratory, diagnostic imaging, pharmacy and rehabilitation services
Naylor 1994	Initial stay mean charges (USD): T = 24,352 ± 15,920 (n = 72) C = 23,810 ± 18,449 (n = 70) Difference 542 (CI − 5121 to 6205) Medical readmission total charges in USD (CIs are in thousands): At 2 weeks: T = 68,754 C = 239,002 Difference = − 170,247 (CI − 253 to − 87) 2‐6 weeks: T = 52,384 C = 189,892 Difference = − 137,508 (CI − 210 to − 67) 6‐12 weeks: T = 471,456 C = 340,496 Difference = 130,960 (CI − 205 to 467)	Charge data were used to calculate the cost of the initial hospitalisation Readmission costs were calculated using the mean charge per day of the index hospitalisations times the actual number of days of subsequent hospitalisations, as patients were readmitted to a variety of hospitals with a wide range of charges Total charges including readmission charges (first readmission only if multiple readmissions)
Rich 1995a	Intervention cost USD 216 per patient Caregiver cost T = USD 1164, C = USD 828 Difference USD 336 Other medical care T = USD 1257, C = USD 1211 Difference USD 46 Readmission costs T = USD 2178, C = USD 3236 Difference − USD 1058 All costs T = USD 4815, C = USD 5275 Difference − USD 460	—


Study	Use of services	Notes
Farris 2014	Unscheduled office visits At 30 d T = 31/281 (11%), C = 32/294 (11%) Difference 0%; 95% CI − 5% to 5% At 90 d T = 42/281 (15%), C = 33/294 (11%) Difference 4%; 95% CI − 2 to 9%	Results for Enhanced vs Control intervention (results for minimal intervention not reported)
Goldman 2014	Primary care visits at 30 d T = 189/301 (62.8%), C = 186/316 (58.9%) Difference 4%; 95% CI − 3.7% to 11.5%	—
Laramee 2003	Visiting Nurse postdischarge: T = 70/141(50%), Control: 64/146 (44%)	—
Nazareth 2001	General practice attendance: At 3 months: T = 101/130 (77.7%) C = 108/144 (75%) Difference 2.7%; 95% CI − 7.4 to 12.7% At 6 months: T = 76/107 (71%) C = 82/116 (70.7%) Difference 0.3%; 95% CI −11.6 to 12.3%	—
Weinberger 1996	Median time from hospital discharge to the first visit: Treatment 7 d Control 13 d P < 0.001 Visit at least one general medicine clinic in 6‐month follow up: Treatment 646/695 (93%) Control 540/701 (77%) Difference 16%; 95% CI 12.3% to 19.6%, P < 0.001 Mean number of visits to general medical clinic: Treatment 3.7 Control 2.2 P < 0.001	—


Study	Number of problems	Notes
Bolas 2004	Intervention group demonstrated a higher rate of reconciliation of patient's own drugs with the discharge prescription; 90% compared to the 44% in the control group	—
Shaw 2000	Mean number of problems (SD) At 1 week: T = 2.0 (1.3), C = 2.5 (1.6) At 4 weeks: T = 1.9 (1.5), C = 2.9 (1.8) At 12 weeks: T = 1.4 (1.2), C = 2.4 (1.6)	Problems included difficulty obtaining a prescription from the GP; insufficient knowledge about medication; non‐compliance


Study	Adherence to medicines	Notes
Nazareth 2001	At 3 months: T = 79, mean 0.75 (SD 0.3), C = 72 mean 0.75 (SD 0.28) At 6 months: T = 60, mean 0.78 (SD 0.30), C = 58 mean 0.78 (SD 0.30)	0 = none 1 = total/highest level
Rich 1995a	Taking 80% or more of prescribed pills at 30 d after discharge T = 117/142 (82.5%), C = 91/140 (64.9%)	—

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Study	Readmission rates	Notes
Farris 2014	At 30 d: I = 47/281 (17%), C = 43/294 (15%) Difference 2%; 95% CI − 0.04% to 0.08% At 90 d: ET = 49/281 (17%), C = 47/294 (16%) Difference 1%; 95% CI − 5% to 8%	—
Gillespie 2009	At 12 months: I = 106/182 (58.2%), C = 110/186 (59.1%) Difference − 0.9%, 95% CI − 10.9% to 9.1%	—
Goldman 2014	At 30 d: I = 50/347 (14%), C = 47/351 (13%) Difference 1%; 95% CI − 4% to 6% At 90 d: I = 89/347 (26%), C = 77/351 (22%) Difference 3.7%; 95% CI − 2.6% to 10%	Data provided by the trialists
Kennedy 1987	At 1 week: I = 2/38 (5%), C = 8/40 (20%) Difference − 15%; 95% CI − 29% to − 0.4% At 8 weeks: I = 11/39 (28%), C = 14/40 (35%) Difference − 7%; 95% CI − 27.2% to 13.6%	—
Lainscak 2013	At 90 d: COPD− related I = 14/118 (12%), C = 33/135 (24%) Difference 12%; 95% CI 3% to 22% All‐cause readmission T = 25/118 (21%), C = 43/135 (32%) Difference 11%; 95% CI − 0.3% to 21%	Data provided by the trialists; data also available for 30− and 180− d
Laramee 2003	At 90 d: T = 49/131 (37%), C = 46/125 (37%), P > 0.99 Readmission days: T= 6.9 (SD 6.5), C = 9.5 (SD 9.8)	—
Moher 1992	At 2 weeks: T = 22/136 (16%), C = 18/131 (14%) Difference 2%; 95% CI − 6% to 11%, P = 0.58	—
Naylor 1994	Within 45‐90 d: T = 11/72 (15%), C = 11/70 (16%) Difference 1%; 95% CI − 8% to 12%	Authors also report readmission data for 2‐6 weeks follow up
Nazareth 2001	At 90 d: T = 64/164 (39%), C = 69/176 (39.2%) Difference 0.18; 95% CI − 10.6% to 10.2% At 180 d: T = 38/136 (27.9%), C = 43/151 (28.4%) Difference 0.54; 95% CI − 11 to 9.9%	—
Shaw 2000	At 90 d: T = 5/51 (10%), C = 12/46 (26%) OR 3.25; 95% CI 0.94 to 12.76, P = 0.06	Authors also report data for readmission due to non‐compliance with medication At 3 months: T = 4/51 (8%), C = 7/46 (15%) Difference − 7%; 95% CI − 0.2 to 0.05
Weinberger 1996	Number of readmissions per month T = 0.19 (+ 0.4) (n = 695), C = 0.14 (+ 0.2), P = 0.005 (n = 701) At 6 months: T = 49%, C = 44%, P = 0.06 Treatment group readmitted 'sooner' (P = 0.07)	Non‐parametric test used to calculate P values for monthly readmissions


Study	Days in hospital	Notes
Evans 1993	Readmission days at 9 months: T = 10.1 ± 8.3, C = 12.1 ± 9.1, P = 0.001; 95% CI − 3.18 to − 0.82	—
Hendriksen 1990	T = 15.5 d per readmission C = 13.5 d per readmission P > 0.05	Not possible to calculate exact P
Rich 1993a	Days to first readmission Overall: T = 31.8 (5.1) (n = 63), C = 42.1 (7.3) (n = 35) Moderate‐risk group: T = 35.1 (9.0) (n = 40), C = 28.6 (7.2) (n = 21) High‐risk group: T = 27.8 (3.5) (n = 23), C = 50.2 (10.5) (n = 14)	—


Study	Place of discharge	Notes
Evans 1993	Discharged to home: T = 330/417 (79%), C = 305/418 (73%) P = 0.04 difference 6%; 95% CI 0.39% to 12% Home at 9 months: T = 259/417 (62%), C = 225/418 (54%) P = 0.01 difference 8.3%; 95% CI 1.6% to 15%	—
Hendriksen 1990	Discharged to nursing home: T = 0/135 (0%), C = 3/138 (2%) Difference − 2%; 95% CI − 4.6% to 0.26% At 6 months: admitted to another institution T = 3/135 (2%), C = 14/138 (10%) Difference ‐8%; 95% CI − 13.5% to − 2.3%	—


Study	Knowledge	Notes
Bolas 2004	Mean error rate in knowledge of drug therapy at 10‐14 d follow up Drug name T = 15%, C = 43%, P < 0.001 Drug dose T = 14%, C = 39%, P < 0.001 Frequency T = 15%, C = 39%, P < 0.001 (n for each group not reported)	—
Nazareth 2001	At 3 months: T = 86, mean 0.69 (SD 0.33) C = 83, mean 0.62 (SD 0.34) At 6 months: T = 65, mean 0.69 (SD 0.35) C = 68, mean 0.68 (SD 0.30) Mean difference 0.01; 95% CI − 0.12 to 0.13	0 = none 1 = total/highest level
Shaw 2000	At 1 and 12 weeks post‐discharge: Significant improvement in knowledge medication for both groups (no differences between groups)	—


Study	Hoarding	Notes
Bolas 2004	90% of people who brought drugs to the hospital were returned in the intervention group compared to 50% in the controls	—
Nazareth 2001	At 3 months: T = 87, mean 0.006 (SD 0.04) C = 82 mean 0.005 (SD 0.03) Mean difference 0.001; 95% CI − 0.01 to 0.012 At 6 months T = 70, mean 0.02 (SD 0.13) C = 69 mean 0.013 (SD 0.06) Mean difference 0.007; 95% CI − 0.013 to 0.27	0 = none 1 = total/highest level


Study
Eggink 2010	Following a review of medication by a pharmacist, 68% in the control group had at least one discrepancy or medication error compared to 39% in the intervention group (RR 0.57; 95% CI 0.37 to 0.88). The percent of medications with a discrepancy or error in the intervention group was 6.1% in intervention group and 14.6% in the control group (RR = 0.42; 0.27 to 0.66).
Kripalani 2012	Clinically important medication errors (total number of events; could be more than one per patient) At 30 d T = 370/423, M = 0.87 (SD 1.18) C = 407/428, M = 0.95 (SD 1.36)

Effect of discharge planning on patients admitted to hospital with a medical condition
Patient or population: patients admitted to hospital Settings: hospital Intervention: discharge planning
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Without discharge planning	With discharge planning
Unscheduled readmission within 3 months of discharge from hospital	Study population admitted with a medical condition		RR 0.87 (0.79 to 0.97)	4743 (15)	⊕⊕⊕⊝ moderate^a	—
	254 per 1000	221 per 1000 (200 to 246)
	Moderate risk population
	285 per 1000	248 per 1000 (225 to 276)
	Study population admitted following a fall		RR 1.36 (0.46 to 4.01)	110 (2)	⊕⊝⊝⊝ very low^b	—
	93 per 1000	126 per 1000 (43 to 371)
	Moderate risk population
	92 per 1000	125 per 1000 (42 to 369)
Hospital length of stay Follow‐up: 3 to 6 months	Study population admitted with a medical condition		—	2193 (12 studies)	⊕⊕⊕⊝ moderate^d	—
	The mean hospital length of stay ranged across control groups from 5.2 to 12.4 days^c	The mean hospital length of stay in the intervention groups was 0.73 lower (95% CI 1.33 to 0.12 lower)
Satisfaction	Discharge planning may lead to increased satisfaction for patients and healthcare professionals.		6 studies		⊕⊕⊝⊝ low	Patient satisfaction was measured in different ways, and findings were not consistent across studies. Only 6/30 studies reported data for this outcome.
Costs	A lower readmission rate for those receiving discharge planning may be associated with lower health service costs in the short term. Differences in use of primary care varied.		5 studies		⊕⊝⊝⊝ very low	Findings were inconsistent. Healthcare resources that were assessed varied among studies, e.g., primary care visits, readmission, length of stay, laboratory services, medication, diagnostic imaging. The charges used to cost the healthcare resources also varied.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio.
GRADE Working Group grades of evidence High:This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different (i.e., large enough to affect a decision) is low. Moderate: This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different is moderate. Low: This research provides some indication of the likely effect. However, the likelihood that it will be substantially different is high. Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different is very high.
^aThe evidence was downgraded to moderate as allocation concealment was unclear for 5 of the 15 trials. ^bThe evidence was downgraded because of imprecision in the results due to 2 small trials. ^cThe range excludes length of stay of 45 days reported by Sulch, as this was an outlier. ^dThe evidence was downgraded to moderate as concealment of random allocation was unclear for 6 of the 11 trials.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hospital length of stay ‐ older patients with a medical condition Show forest plot	12	2193	Mean Difference (IV, Fixed, 95% CI)	‐0.73 [‐1.33, ‐0.12]

2 Sensitivity analysis imputing missing SD for Kennedy trial Show forest plot	11	1825	Mean Difference (IV, Fixed, 95% CI)	‐0.98 [‐1.57, ‐0.38]

3 Hospital length of stay ‐ older surgical patients Show forest plot	2	184	Mean Difference (IV, Fixed, 95% CI)	‐0.06 [‐1.23, 1.11]

4 Hospital length of stay ‐ older medical and surgical patients Show forest plot	2	1108	Mean Difference (IV, Fixed, 95% CI)	‐0.60 [‐2.38, 1.18]

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