Interventions to reduce hospital readmissions in the elderly: in-hospital or home care. A systematic review.
OBJECTIVE
Unplanned hospital readmissions of elderly people represent an increasing burden on health care systems. This burden could theoretically be reduced by adequate preventive interventions, although there is uncertainty about the effectiveness of different types of interventions. The objective of this systematic review was to identify interventions that effectively reduce the risk of hospital readmissions in patients of 75 years and older, and to assess the role of home follow-up.


METHODS
We searched studies in MEDLINE, CINAHL, CENTRAL and seven other electronic databases up to October 2007, and we updated the MEDLINE search in October 2009. Clinical trials (randomized or controlled) evaluating the effectiveness of an intervention aimed at reducing readmissions in elderly patients were selected. Quality was assessed using the SIGN tool and the information extracted is presented in text and tables.


RESULTS
Thirty-two clinical trials were included and they were divided into two groups: in-hospital interventions (17 studies) and interventions with home follow-up (15 studies). A positive effect of the intervention evaluated on the readmission outcome was found in three studies from the first group and in seven from the second group.


CONCLUSIONS
Most of the interventions evaluated did not have any effect on the readmission of elderly patients. However, those interventions that included home care components seem to be more likely to reduce readmissions in the elderly.
Linertová
Renata
R
Canary Islands Foundation for Health and Research (FUNCIS), Santa Cruz de Tenerife, Spain. renata.linertova@sescs.es
García-Pérez
Lidia
L
Vázquez-Díaz
José Ramón
JR
Lorenzo-Riera
Antonio
A
Sarría-Santamera
Antonio
A
D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D015577:Geriatric Assessment; D006699:Home Care Services / Q000458:organization & administration*; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge; D012308:Risk Management / Q000458:organization & administration*