Table 3: Results of Two Meta-Analyses – Comparison of Individualized Discharge Planning Versus Usual Care and Comprehensive Discharge Planning With Postdischarge Support Versus Usual Care.
| Intervention/Author | Summary Statistic RR (95% CI) |
Number of RCTs | N | Heterogeneity P Value |
|---|---|---|---|---|
| Readmission to Hospital | ||||
| Individualized discharge planning Shepperd et al, 2009a (4) |
0.85 (0.74–0.97) (Follow-up from 2 weeks to 9 months) |
11 | 2,552 | 0.47 |
| Individualized discharge planning WITH postdischarge support Phillips et al, 2004b (11) |
0.74 (0.67–0.81) (Follow-up from 3–12 months; mean, 8 months) |
17 | 2,941 | 0.04 (significant heterogeneity remained even after a large study was removed due to considerable significant heterogeneity [P < 0.001] in 18 studies) |
| Mortality | ||||
| Individualized discharge planning Shepperd et al, 2009a (4) |
1.04 (0.74–1.46) | 4 | 978 | 0.44 |
| Individualized discharge planning WITH postdischarge support Phillips et al, 2004 (11) |
0.87 (0.73–1.03) | 14 | 2,847 | 0.06 |
| Length of Stay | ||||
| Individualized discharge planning Shepperd et alb, 2009 (4) |
Mean difference –0.91 (–1.55 to –0.27) | 10 | 1,765 | 0.50 |
| Individualized discharge planning WITH postdischarge support Phillips et al, 2004 (11) |
Mean difference –0.37 (–0.15 to 0.60) | 10 | 1,682 | Not reported |
Abbreviations: CI, confidence interval; RCT, randomized controlled trials; RR, relative risk.
This systematic review specifically focused on discharge planning. Studies were excluded if it was not possible to separate the effects of discharge planning from the other components of the intervention, if discharge planning appeared to be a minor part of a multifaceted intervention, or if the focus was on the provision of care after discharge from hospital. The control group had to receive standard care with no structured discharge planning.
Included studies specifically addressed congestive heart failure, described components for inpatient care plus postdischarge support, compared the effects with usual care, and reported readmission rates as the primary outcome.