title: Pediatric hospital discharge interventions to reduce subsequent utilization: a systematic review.
abstract: BACKGROUND
  Reducing avoidable readmission and posthospitalization emergency department (ED) utilization has become a focus of quality-of-care measures and initiatives. For pediatric patients, no systematic efforts have assessed the evidence for interventions to reduce these events.
  
  
  OBJECTIVE
  We sought to synthesize existing evidence on pediatric discharge practices and interventions to reduce hospital readmission and posthospitalization ED utilization.
  
  
  METHODS
  PubMed and the Cumulative Index to Nursing and Allied Health Literature.
  
  
  METHODS
  Studies available in English involving pediatric inpatient discharge interventions with at least 1 outcome of interest were included.
  
  
  METHODS
  We utilized a modified Cochrane Good Practice data extraction tool and assessed study quality with the Downs and Black tool.
  
  
  RESULTS
  Our search identified a total of 1296 studies, 14 of which met full inclusion criteria. All included studies examined multifaceted discharge interventions initiated in the inpatient setting. Overall, 2 studies demonstrated statistically significant reductions in both readmissions and subsequent ED visits, 4 studies demonstrated statistically significant reductions in either readmissions or ED visits, and 2 studies found statistically significant increases in subsequent utilization. Several studies were not sufficiently powered to detect changes in either subsequent utilization outcome measure.
  
  
  CONCLUSIONS
  Interventions that demonstrated reductions in subsequent utilization targeted children with specific chronic conditions, providing enhanced inpatient feedback and education reinforced with postdischarge support. Interventions seeking to reduce subsequent utilization should identify an individual or team to assume responsibility for the inpatient-to-outpatient transition and offer ongoing support to the family via telephone or home visitation following discharge.
authors.affiliation: Department of Pediatrics, Division of Hospital Medicine, James M. Anderson Center for Health Care Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Auger
authors.forename: Chén C
authors.initials: CC
authors.lastname: Kenyon
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D010353:Patient Education as Topic; D010358:Patient Participation; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration*