title: Improving patient handovers from hospital to primary care: a systematic review.
abstract: BACKGROUND
  Evidence shows that suboptimum handovers at hospital discharge lead to increased rehospitalizations and decreased quality of health care.
  
  
  OBJECTIVE
  To systematically review interventions that aim to improve patient discharge from hospital to primary care.
  
  
  METHODS
  PubMed, CINAHL, PsycInfo, the Cochrane Library, and EMBASE were searched for studies published between January 1990 and March 2011.
  
  
  METHODS
  Randomized, controlled trials of interventions that aimed to improve handovers between hospital and primary care providers at hospital discharge.
  
  
  METHODS
  Two reviewers independently abstracted data on study objectives, setting and design, intervention characteristics, and outcomes. Studies were categorized according to methodological quality, sample size, intervention characteristics, outcome, statistical significance, and direction of effects.
  
  
  RESULTS
  Of the 36 included studies, 25 (69.4%) had statistically significant effects in favor of the intervention group and 34 (94.4%) described multicomponent interventions. Effective interventions included medication reconciliation; electronic tools to facilitate quick, clear, and structured summary generation; discharge planning; shared involvement in follow-up by hospital and community care providers; use of electronic discharge notifications; and Web-based access to discharge information for general practitioners. Statistically significant effects were mostly found in reducing hospital use (for example, rehospitalizations), improvement of continuity of care (for example, accurate discharge information), and improvement of patient status after discharge (for example, satisfaction).
  
  
  CONCLUSIONS
  Heterogeneity of the interventions and study characteristics made meta-analysis impossible. Most studies had diffuse aims and poor descriptions of the specific intervention components.
  
  
  CONCLUSIONS
  Many interventions have positive effects on patient care. However, given the complexity of interventions and outcome measures, the literature does not permit firm conclusions about which interventions have these effects.
  
  
  BACKGROUND
  The European Union, the Framework Programme of the European Commission.
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. g.hesselink@iq.umcn.nl
authors.forename: Gijs
authors.initials: G
authors.lastname: Hesselink
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.forename: Paul
authors.initials: P
authors.lastname: Barach
authors.forename: Anouk
authors.initials: A
authors.lastname: Spijker
authors.forename: Petra
authors.initials: P
authors.lastname: Gademan
authors.forename: Cor
authors.initials: C
authors.lastname: Kalkman
authors.forename: Janine
authors.initials: J
authors.lastname: Liefers
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
mesh_terms: D003153:Community Health Services; D006801:Humans; D010351:Patient Discharge / Q000592:standards*; D062209:Patient Handoff / Q000592:standards*; D010359:Patient Readmission; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic