title: Improving patient discharge and reducing hospital readmissions by using Intervention Mapping.
abstract: BACKGROUND
  There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge.
  
  
  METHODS
  The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.
  
  
  RESULTS
  Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change.
  
  
  CONCLUSIONS
  This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.
authors.affiliation: Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P,O, Box 9101, 6500 HB, Nijmegen, The Netherlands. gijs.hesselink@radboudumc.nl.
authors.forename: Gijs
authors.initials: G
authors.lastname: Hesselink
authors.forename: Marieke
authors.initials: M
authors.lastname: Zegers
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.forename: Paul
authors.initials: P
authors.lastname: Barach
authors.forename: Cor
authors.initials: C
authors.lastname: Kalkman
authors.forename: Maria
authors.initials: M
authors.lastname: Flink
authors.forename: Gunnar
authors.initials: G
authors.lastname: Öhlen
authors.forename: Mariann
authors.initials: M
authors.lastname: Olsson
authors.forename: Susanne
authors.initials: S
authors.lastname: Bergenbrant
authors.forename: Carola
authors.initials: C
authors.lastname: Orrego
authors.forename: Rosa
authors.initials: R
authors.lastname: Suñol
authors.forename: Giulio
authors.initials: G
authors.lastname: Toccafondi
authors.forename: Francesco
authors.initials: F
authors.lastname: Venneri
authors.forename: Ewa
authors.initials: E
authors.lastname: Dudzik-Urbaniak
authors.forename: Basia
authors.initials: B
authors.lastname: Kutryba
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
mesh_terms: D005060:Europe; D017144:Focus Groups; D006739:Hospital Administration; D006801:Humans; D007407:Interviews as Topic; D010351:Patient Discharge / Q000592:standards*; D062209:Patient Handoff; D010359:Patient Readmission; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*