Transitional care clinics for patients discharged from hospital without a primary care provider: A systematic review.
Journal
Journal of hospital medicine
ISSN: 1553-5606
Titre abrégé: J Hosp Med
Pays: United States
ID NLM: 101271025
Informations de publication
Date de publication:
16 Apr 2024
16 Apr 2024
Historique:
revised:
21
03
2024
received:
17
10
2023
accepted:
23
03
2024
medline:
16
4
2024
pubmed:
16
4
2024
entrez:
16
4
2024
Statut:
aheadofprint
Résumé
The transition from hospital to home is a high-risk period. Timely follow-up care is essential to reducing avoidable harms such as adverse drug events, yet may be unattainable for patients who lack attachment to a primary care provider. Transitional care clinics (TCCs) have been proposed as a measure to improve health outcomes for patients discharged from hospital without an established provider. In this systematic review, we compared outcomes for unattached patients seen in TCCs after hospital discharge relative to care as usual. We searched the following bibliographic databases for articles published on or before August 12, 2022: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PsycINFO, and Web of Science. Five studies were identified that examined the effects of a dedicated postdischarge clinic on emergency department (ED) visits, readmissions, and/or mortality within 90 days of discharge for patients with no attachment to a primary care provider. Studies were heterogeneous in design and quality; all were from urban centers within the United States. Four of the five studies reported a reduction in either the number of ED visits or readmissions in patients seen in a TCC following hospitalization. TCCs may be effective in reducing hospital contacts in the period following hospital discharge in patients with no established primary care provider. Further studies are required to evaluate the health benefits attributable to the implementation of TCCs across a broad range of practice contexts, as well as the cost implications of this model.
Sections du résumé
BACKGROUND
BACKGROUND
The transition from hospital to home is a high-risk period. Timely follow-up care is essential to reducing avoidable harms such as adverse drug events, yet may be unattainable for patients who lack attachment to a primary care provider. Transitional care clinics (TCCs) have been proposed as a measure to improve health outcomes for patients discharged from hospital without an established provider. In this systematic review, we compared outcomes for unattached patients seen in TCCs after hospital discharge relative to care as usual.
METHODS
METHODS
We searched the following bibliographic databases for articles published on or before August 12, 2022: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PsycINFO, and Web of Science. Five studies were identified that examined the effects of a dedicated postdischarge clinic on emergency department (ED) visits, readmissions, and/or mortality within 90 days of discharge for patients with no attachment to a primary care provider.
RESULTS
RESULTS
Studies were heterogeneous in design and quality; all were from urban centers within the United States. Four of the five studies reported a reduction in either the number of ED visits or readmissions in patients seen in a TCC following hospitalization.
CONCLUSIONS
CONCLUSIONS
TCCs may be effective in reducing hospital contacts in the period following hospital discharge in patients with no established primary care provider. Further studies are required to evaluate the health benefits attributable to the implementation of TCCs across a broad range of practice contexts, as well as the cost implications of this model.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.
Références
Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345‐349.
Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2(5):314‐323.
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161‐167.
Gonçalves‐Bradley DC, Lannin NA, Clemson LM, Cameron ID, Shepperd S. Discharge planning from hospital. Cochrane Database Syst Rev. 2016;2016(1):CD000313.
Anderson A, Mills CW, Willits J, et al. Follow‐up post‐discharge and readmission disparities among Medicare fee‐for‐service beneficiaries. J Gen Intern Med. 2022;37(12):3020‐3028.
Riverin BD, Strumpf EC, Naimi AI, Li P. Optimal timing of physician visits after hospital discharge to reduce readmission. Health Serv Res. 2018;53(6):4682‐4703.
Jackson C, Shahsahebi M, Wedlake T, DuBard CA. Timeliness of outpatient follow‐up: an evidence‐based approach for planning after hospital discharge. Ann Fam Med. 2015;13(2):115‐122.
Virapongse A, Misky GJ. Self‐identified social determinants of health during transitions of care in the medically underserved: a narrative review. J Gen Intern Med. 2018;33(11):1959‐1967.
Appleton AJ, Lam M, Allen BN, Richard L, Shariff SZ, Gershon AS. Potential barriers to physician follow‐up within 7 days of discharge from a chronic obstructive pulmonary disease hospital admission. Can J Resp Crit Care Sleep Med. 2021;5(5):283‐292.
Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of primary care physician supply with population mortality in the United States, 2005‐2015. JAMA Int Med. 2019;179(4):506‐514.
Government of Canada. Primary health care providers, 2019. 2020. Accessed March 19, 2023. https://www150.statcan.gc.ca/n1/pub/82-625-x/2020001/article/00004-eng.htm
Breton M, Wong S, Smithman M, et al. Centralized waiting lists for unattached patients in primary care: learning from an intervention implemented in seven Canadian provinces. Healthcare Policy. 2018;13(4):65‐82.
OurCare. 2023. Accessed April 11, 2023. https://www.ourcare.ca/
Kiran T, Green ME, Wu CF, et al. Family physicians stopping practice during the COVID‐19 pandemic in Ontario, Canada. Ann Fam Med. 2022;20(5):460‐463.
The Canadian Collaborative Taskforce. Advancing Rural Family Medicine: The Canadian Collaborative Taskforce. The rural road map for action – directions [Internet]. 2017. https://www.cfpc.ca/CFPC/media/Resources/Rural-Practice/Rural-Road-Map-Directions-ENG.pdf
Gudbranson E, Glickman A, Emanuel EJ. Reassessing the data on whether a physician shortage exists. JAMA. 2017;317(19):1945‐1946.
Sabety AH, Jena AB, Barnett ML. Changes in health care use and outcomes after turnover in primary care. JAMA Int Med. 2021;181(2):186‐194.
Basu S, Phillips RS, Berkowitz SA, Landon BE, Bitton A, Phillips RL. Estimated effect on life expectancy of alleviating primary care shortages in the United States. Ann Intern Med. 2021;174(7):920‐926.
Doctoroff L. Postdischarge clinics and hospitalists: A review of the evidence and existing models. J Hosp Med. 2017;12(6):467‐471.
Takeda A, Martin N, Taylor RS, Taylor SJ. Disease management interventions for heart failure. Cochrane Database Syst Rev. 2019;2019(1):CD002752.
Ridwan ES, Hadi H, Wu YL, Tsai PS. Effects of transitional care on hospital readmission and mortality rate in subjects with COPD: a systematic review and meta‐analysis. Respir Care. 2019;64(9):1146‐1156.
Liss DT, Ackermann RT, Cooper A, et al. Effects of a transitional care practice for a vulnerable population: a pragmatic, randomized comparative effectiveness trial. J Gen Intern Med. 2019;34(9):1758‐1765.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40‐46.
DistillerSR Inc. DistillerSR [Internet]. 2022. Accessed August 2022–February 2023. https://www.distillersr.com/
Office of Health Assessment and Translation (OHAT). Handbook for conducting a literature‐based health assessment using OHAT approach for systematic review and evidence integration. National Institute of Environmental Health Sciences; 2019. https://ntp.niehs.nih.gov/ntp/ohat/pubs/riskofbiastool_508.pdf
Rotenstein L, Melia C, Samal L, et al. Development of a primary care transitions clinic in an academic medical center. J Gen Intern Med. 2022;37(3):582‐589.
Seggelke SA, Hawkins RM, Gibbs J, Rasouli N, Wang C, Draznin B. Transitional care clinic for uninsured and medicaid‐covered patients with diabetes mellitus discharged from the hospital: a pilot quality improvement study. Hosp Pract. 2014;42(1):46‐51.
Chakravarthy V, Ryan MJ, Jaffer A, et al. Efficacy of a transition clinic on hospital readmissions. Am J Med. 2018;131(2):178‐184.e1.
Lee J, Reyes F, Islam M, et al. Outcomes of a transitional care clinic to reduce heart failure readmissions at an urban academic medical center. Int J Clin Res Trials. 2019;4(2):140.
Levine DM, Landon BE, Linder JA. Quality and experience of outpatient care in the United States for adults with or without primary care. JAMA Int Med. 2019;179(3):363‐372.
Glazier RH, Moineddin R, Agha MM, et al. The impact of not having a primary care physician among people with chronic conditions [Internet]. Institute for Clinical Evaluative Sciences; 2008. https://www.ices.on.ca/flip-publication/the-impact-of-not-having-a-primary-care-physician-chronic-conditions/files/assets/basic-html/index.html
Hay C, Pacey M, Bains N, Ardal S. Understanding the unattached population in Ontario: evidence from the Primary Care Access Survey (PCAS). Healthcare Policy | Politiques de Santé. 2010;6(2):33‐47.
Cummings E, Martinez S, Mourad M. Primary care gap: factors associated with persistent lack of primary care after hospitalisation. BMJ Open Qual. 2022;11(1):e001666.
Baker R, Freeman GK, Haggerty JL, Bankart MJ, Nockels KH. Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract. 2020;70(698):e600‐e611.
Breton M, Smithman MA, Sasseville M, et al. How the design and implementation of centralized waiting lists influence their use and effect on access to healthcare: a realist review. Health Policy. 2020;124(8):787‐795.
Government of Canada. Research highlights on health and aging [Internet]. 2016. Accessed March 19, 2023. https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2016001-eng.htm
Doctoroff L, Nijhawan A, McNally D, Vanka A, Yu R, Mukamal KJ. The characteristics and impact of a hospitalist‐staffed post‐discharge clinic. Am J Med. 2013;126(11):1016.e9‐1016.e15. doi:10.1016/j.amjmed.2013.03.025
Elliott K, W. Klein J, Basu A, Sabbatini AK. Transitional care clinics for follow‐up and primary care linkage for patients discharged from the ED. Am J Emerg Med. 2016;34(7):1230‐1235. doi:10.1016/j.ajem.2016.03.029
Baldwin SM, Zook S, Sanford J. Implementing posthospital interprofessional care team visits to improve care transitions and decrease hospital readmission rates. Prof Case Manag. 2018;23(5):264‐271. doi:10.1097/NCM.0000000000000284
Murrow JR, Rabeeah Z, Osei K, Apaloo C. Reducing costs and improving care after hospitalization: economic evaluation of a novel transitional care clinic. Health Serv Manage Res. 2022;35(3):164‐171. doi:10.1177/09514848211028710
Shah RR, Mehta MP, Radakrishnan A, et al. Improving use of a hospital transitional care clinic. Joint Commission J Qual Patient Safety. 2020;46(12):673‐681. doi:10.1016/j.jcjq.2020.08.008
Balucan FS, French B, Shi Y, Kripalani S, Vasilevskis EE. Screening for the high‐need population using single institution versus state‐wide admissions discharge transfer feed. BMC Health Serv Res. 2023;23(1):1111. doi:10.1186/s12913-023-10017-5