Telephone Follow-up as a Primary Care Intervention for Postdischarge Outcomes Improvement: A Systematic Review

doi:10.1016/j.amjmed.2012.01.035

The American Journal of Medicine

Volume 125, Issue 9, September 2012, Pages 915-921

https://doi.org/10.1016/j.amjmed.2012.01.035 Get rights and content

Abstract

Objective

Postdischarge telephone follow-up plays an integral part in transitional care efforts in many regions. We systematically reviewed the literature to evaluate the evidence regarding the impact of primary care–based telephone follow-up on postdischarge emergency department visits and hospital readmissions.

Methods

We performed an electronic database search for relevant telephone follow-up studies originating in adult primary care settings.

Results

Only 3 studies (N = 1765) met entry criteria for this review. None of the studies demonstrated evidence of reduced admissions or emergency department visits from primary care–based telephone follow-ups. All 3 studies reported improved primary care office contact as a result of telephone follow-up intervention.

Conclusions

Despite the growing use of primary care-based telephone follow-up in the postdischarge period, there are no high-quality studies demonstrating its benefit. However, its positive impact on patient engagement holds potentially meaningful implications. In light of recent national health care legislation, the primary care field is ripe for high-quality studies to evaluate the effectiveness of telephone follow-up for patients in the postdischarge period. Particular areas of research focus are discussed.

Section snippets

Materials and Methods

We performed an electronic search of Ovid Medline, Ovid Nursing Database, PsychINFO, EBM Reviews, and EMBASE from the beginning of indexing (1948 for Ovid Databases, 1967 for PsychINFO, 1974 for EMBASE) to December 7, 2011, for studies that reported the effect of primary care–based telephone follow-up on postdischarge outcomes.

Search Results

After limiting the search to the stipulated criteria, 166 citations remained (Figure). Fifty-five duplicate citations were removed, leaving 111 citations. After review for further eligibility, 61 articles did not include telephone follow-up as a primary intervention. Thirty articles included telephone follow-up, but not as an independent or primary intervention or as a primary care–based intervention. Despite a priori selection of studies involving adult populations, 8 pediatric articles were

Implications of Key Findings

Prior studies evaluating hospital-based telephone follow-up as a component of transitional care have demonstrated reduced postdischarge emergency department visit and hospital readmission rates, cost, and improved quality of life and continuity of care21, 22, 23 by discharge planners,24, 25, 26 health transition coaches,²⁷ nurse liaisons,²⁸ and pharmacists.29, 30, 31 Our systematic review analyzed the effect of published primary care–based telephone follow-up studies on postdischarge outcomes.

Conclusions

Hospitalization often creates discontinuity of care, which can lead to adverse events, including increased hospital readmission and unnecessary resource use. Although there may be a perceived role for primary care-based telephone follow-up, our review found an alarming paucity of published trials addressing this intervention and no demonstrable effectiveness in reducing posthospitalization readmissions or emergency department visits, but it did show improved ability to engage patients in

Acknowledgment

Dr J. Benjamin Crocker thanks the Richard Winickoff Primary Care Fellowship at Massachusetts General Hospital.

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: Conflict of Interest: None.

: Authorship: All authors had access to the data and played a role in writing this manuscript.

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Clinical research studyTelephone Follow-up as a Primary Care Intervention for Postdischarge Outcomes Improvement: A Systematic Review

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Materials and Methods

Search Results

Implications of Key Findings

Conclusions

Acknowledgment

J Chronic Dis

J Clin Epidemiol

Mayo Clin Proc

Res Social Adm Pharm

J Am Pharm Assoc

Senate passes healthcare overhaul bill

New York Times

Rehospitalizations among patients in the Medicare fee-for-service program

N Engl J Med

Improving the quality of transitional care for persons with complex care needs

J Am Geriatr Soc

Continuity of outpatient and inpatient care by primary care physicians for hospitalized older adults

JAMA

The hospitalist movement 5 years later

JAMA

A geriatric hospitalist program for nursing home residents

Ann Longterm Care

Hospitalists and care transitions: the divorce of inpatient and outpatient care

Health Aff (Millwood)

Growth in the care of older patients by hospitalists in the United States

N Engl J Med

Prospective payment system and impairment at discharge: the quicker-and-sicker story revisited

JAMA

Comprehensive discharge planning for hospitalized elderly: a pilot study

Nurs Res

Executing high-quality care transitions: a call to do it right

J Hosp Med

Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems

Medicine

Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study

Ann Intern Med

Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home

Cochrane Database Syst Rev

Postdischarge care and readmissions

Med Care

A case manager intervention to reduce readmissions

Arch Intern Med

Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study

J Gen Intern Med

Effect of a nurse case manager on postdischarge follow-up

J Gen Intern Med

Effects of a multidisciplinary, post-discharge continuance of care intervention on quality of life, discharge satisfaction, and hospital length of stay: a randomized controlled trial

Int J Qual Health Care

Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?

J Gen Intern Med

Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle

J Hosp Med

Comprehensive discharge planning and home follow-up of hospitalized elders

JAMA

Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure

JAMA

The care transitions intervention: results of a randomized controlled trial

Arch Intern Med

Randomised controlled trial of specialist nurse intervention in heart failure

BMJ

A reengineered hospital discharge program to decrease rehospitalization: a randomized trial

Ann Intern Med

Clinical research study
Telephone Follow-up as a Primary Care Intervention for Postdischarge Outcomes Improvement: A Systematic Review