Table 4.
Effectiveness of TPAD Interventions*
| Study | Primary Outcome(s) | Event rate (intervention vs. control) | Impact† |
|---|---|---|---|
| Balaban12 | No outpatient appointment within 21 days with either an MD or NP at the patient’s primary care site or with a relevant specialist | 7/47 (15%) vs. 20/49 (41%) (p 0.005) Historic control 35/100 (35%) |
Negative |
| Readmission, for any reason, within 31 days to any of the 3 CHA hospitals | 4/49 (8%) vs. 4/49 (8%) (p 0.96) Historic control 14/100 (14%) |
||
| Emergency department visits within 31 days for a problem related to the original admission in any of the 3 CHA hospitals | 1/49 (2%) vs. 1/49 (2%) (p 0.97) Historic control 8/100 (8%) |
||
| Failure to complete an outpatient workup recommended by a hospital doctor | 3/26 (12%) vs. 5/16 (31%) (p 0.11) Historic control 13/42 (31%) |
||
| Dalal13 | Self-reported awareness of TPAD results by attending physician | 106/139 (76%) vs. 52/136 (38%) (p < 0.001) | Positive |
| Dinescu14 | Admission composite | 93/100 (93%) vs. 70/100 (70%) (p 0.001) | Positive |
| Hospital course composite | 93/100 (93%) vs. 78/100 (78%) (p 0.001) | ||
| Discharge planning composite | 93/100 (93%) vs. 77/100 (77%) (p 0.02) | ||
| Post-discharge care composite Follow-up results documented |
83/100 (83%) vs. 57/100 (57%) (p < 0.001) 81/100 (81%) vs. 42/100 (42%) (p 0.02) |
||
| El-Kareh15 | Presence in the patient’s outpatient electronic chart of documentation (note describing follow-up with the patient, note with acknowledgement of the result, or new antibiotic prescription) of follow-up action within 3 days of the post-discharge microbiology result | 27/97 (28%) vs. 8/60 (13%) (p 0.01) | Positive |
| Graumlich16 | Proportion of patients readmitted at least once within 6 months after the index hospitalization | 117/316 (37%) vs. 119/314 (38%) (p 0.897) | Negative |
| Kantor17 | Proportion of pending studies communicated in discharge summary | 43% vs. 18% (p 0.001) | Positive |
| Proportion of discharge summaries communicated all pending studies | 26% vs. 8% (p 0.002) | ||
| O’Leary18 | DSCS (out of 100) | 80.3 vs. 74.1 (p 0.007) | Positive |
| Pending tests documented in discharge summary | 44/95 (46%) vs. 14/101 (13%) (p 0.001) | ||
| Cadwallader19 | Frequency of tests with pending results that were documented in the discharge summaries | 178/812 (22%) vs. 87/701 (12%) (p 0.02) | Positive |
| Jack20 | Number of emergency department visits and readmissions per participant within 30 days of the index discharge | 116/370 (31%) vs. 166/368 (45%) (p 0.009) | Positive |
*Abbreviations: CHA, Cambridge Health Alliance; DSCS, Discharge Summary Completeness Score; MD, medical doctor; NP, nurse practitioner; TPAD, test pending at discharge
†Impact is defined as ≥ 50% of primary outcomes positive with p < 0.0511